Isaac Anihili Thelin, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

202009552NP-PP Issued in OR

Practice address

700 NE Multnomah St Ste 275
Portland, OR 97232-4103

Phone

(503) 729-1380

NPI assigned

Oct 20, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Willamette Health & Wellness LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Portland, OR
  • NPI 1093140188
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1558960682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3331 NE 61ST AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972133933",
            "telephone_number": "503-896-7112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 NE MULTNOMAH ST STE 275",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972324103",
            "telephone_number": "503-729-1380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THELIN",
        "first_name": "ISAAC",
        "middle_name": "ANIHILI",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-20",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "202009552NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Wig Gallery LLC
• Sandra Thein
• Andria D Theiss, BS
• Divya Thekkethala Winovich, MPH
• Elyssa Thelin
• Molly Elizabeth Thelisdort, N.D., L.AC.
• Thelma Jean Mays MD PC
• Thelma Vega LLC
• Jayde Theobald, LMT
• Sarah Theodoroff, PH.D.

• Psychiatric/Mental Health Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.