Individual
TINA NANETTE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
440 NE 66TH AVE, PORTLAND, OR 97213-5026
(503) 407-5525
Mailing address
440 NE 66TH AVE, PORTLAND, OR 97213-5026
(503) 407-5525
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
16227
OR
Other
Enumeration date
05/17/2012
Last updated
05/17/2012
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