Provider Demographics
NPI:1003890351
Name:COEHLO, THOMAS EUGENE (RN, MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EUGENE
Last Name:COEHLO
Suffix:
Gender:M
Credentials:RN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 SW CROWELL WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1178
Mailing Address - Country:US
Mailing Address - Phone:541-385-5515
Mailing Address - Fax:541-385-5578
Practice Address - Street 1:132 SW CROWELL WAY STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1178
Practice Address - Country:US
Practice Address - Phone:541-385-5515
Practice Address - Fax:541-385-5578
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR090007430N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006372Medicaid
OR006372Medicaid