Provider Demographics
NPI:1558960682
Name:THELIN, ISAAC ANIHILI (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:ANIHILI
Last Name:THELIN
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 NE 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3933
Mailing Address - Country:US
Mailing Address - Phone:503-896-7112
Mailing Address - Fax:
Practice Address - Street 1:700 NE MULTNOMAH ST STE 275
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-4103
Practice Address - Country:US
Practice Address - Phone:503-729-1380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202009552NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health