Provider Demographics
NPI:1861848657
Name:HEALLY, ELLISA (RN)
Entity type:Individual
Prefix:
First Name:ELLISA
Middle Name:
Last Name:HEALLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ELLISA
Other - Middle Name:
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:917 SW OAK ST STE 309
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2806
Mailing Address - Country:US
Mailing Address - Phone:541-230-8302
Mailing Address - Fax:
Practice Address - Street 1:917 SW OAK ST STE 309
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2806
Practice Address - Country:US
Practice Address - Phone:541-230-8302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201703649RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty