Individual
HEATHER THOMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, QMHP
Contact information
Practice address
137 HALL AVE, COOS BAY, OR 97420-1519
(541) 236-2088
Mailing address
95440 LILLIAN SLOUGH LN, COOS BAY, OR 97420-7557
(330) 819-8931
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201807240RN
OR
163WP0808X
Psychiatric/Mental Health Registered Nurse
24-QMHP-R-2651
OR
Other
Enumeration date
03/25/2024
Last updated
03/25/2024
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