Provider Demographics
NPI:1649325796
Name:THURSTON, CHRISTINE ANNE (RN, PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ANNE
Last Name:THURSTON
Suffix:
Gender:F
Credentials:RN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 GREENRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1428
Mailing Address - Country:US
Mailing Address - Phone:503-697-4624
Mailing Address - Fax:
Practice Address - Street 1:412 SW 12TH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209
Practice Address - Country:US
Practice Address - Phone:503-228-7134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health