Individual
NDEYE THIAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-2099
(541) 267-5151
(541) 266-4567
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-2099
(541) 267-5151
(541) 266-4567
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA213413
OR
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
02/09/2022
Last updated
10/12/2022
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