Healthcare Provider Details

I. General information

NPI: 1881269009
Provider Name (Legal Business Name): THOMAS FRANKLIN OHARRA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12452 TOWNER AVE NE
ALBUQUERQUE NM
87112-3660
US

IV. Provider business mailing address

PO BOX 45216
RIO RANCHO NM
87174-5216
US

V. Phone/Fax

Practice location:
  • Phone: 505-350-2638
  • Fax:
Mailing address:
  • Phone: 505-350-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberR35834
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: