Individual
MR. NATHANIEL WADE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRM, PSS
Contact information
Practice address
7712 SW 45TH AVE APT 71, PORTLAND, OR 97219-1591
(503) 962-0194
Mailing address
7712 SW 45TH AVE APT 71, PORTLAND, OR 97219-1591
(503) 962-0194
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
20-CRM-150
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-CRM-150
MHACBO
OR
Enumeration date
04/13/2022
Last updated
04/13/2022
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