Provider Demographics
NPI:1023005980
Name:THOMAS, BERNADETTE K (APRN, MSN, MPH, DNP)
Entity type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:K
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN, MSN, MPH, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 NW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3964
Mailing Address - Country:US
Mailing Address - Phone:503-988-3581
Mailing Address - Fax:
Practice Address - Street 1:619 SW 6TH AVE.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-9720
Practice Address - Country:US
Practice Address - Phone:503-988-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202109686NP-PP363LF0000X
OR2004440440RN163W00000X
CT003279363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022959Medicaid
CT004236346Medicaid
500001560Medicare PIN