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Alexandria Raene Thacker
Psychiatric/Mental Health Nurse Practitioner in Tigard, Oregon
NPI 1205568300

Alexandria Raene Thacker is a Psychiatric/Mental Health Nurse Practitioner based in Tigard, OR and is specialized in Psychiatric/Mental Health. Alexandria Raene Thacker practices in Tigard, OR. The NPI Number for Alexandria Raene Thacker is 1205568300 and holds a License No. AP61370661 (Oregon).

The current practice location address for Alexandria Raene Thacker is 12115 Sw 70Th Ave Ste 202, Tigard, OR and can be reached out via phone at 503-404-2338.

Location: 12115 Sw 70Th Ave Ste 202, Tigard, OR, 97223-9648
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1205568300
Provider Name
Alexandria Raene Thacker
Credential
Provider Entity Type
Individual
Gender
Female
Address
12115 Sw 70Th Ave Ste 202, Tigard, OR, 97223-9648
Phone Number
503-404-2338
Fax Number
Provider Enumeration Date
06/28/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
12115 Sw 70Th Ave Ste 202
City
Tigard
State
Oregon
Zip
97223-9648
Phone Number
503-404-2338
Fax Number
person
Provider Business Mailing Address Details
Address
12115 Sw 70Th Ave Ste 202
City
Tigard
State
Oregon
Zip
97223-9648
Phone Number
503-404-2338
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Psychiatric/Mental Health
Taxonomy
363LP0808X
License No.
AP61370661 (Washington)
Definition
Definition to come...
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