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1205568300
ALEXANDRIA RAENE THACKER
TIGARD, OR
NPI
1205568300
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: WA AP61370661)
Enumeration Date
2022-06-28
Last Update Date
2022-11-22
Business Address
ALEXANDRIA RAENE THACKER
12115 SW 70TH AVE STE 202
TIGARD, OR 97223-9648
Phone number: 503-404-2338
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Mailing Address
ALEXANDRIA RAENE THACKER
12115 SW 70TH AVE STE 202
TIGARD, OR 97223-9648
Phone number: 503-404-2338
Copy
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