Individual
THOMAS DAVID SANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP
Contact information
Practice address
4400 NE HALSEY ST STE 102, PORTLAND, OR 97213-1545
(503) 962-1000
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
201904282RN
OR
363L00000X
Nurse Practitioner
201904283NP-PP
OR
363LG0600X
Gerontology Nurse Practitioner
Primary
201904283NP-PP
OR
Other
Enumeration date
12/19/2019
Last updated
04/03/2026
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