Healthcare Provider Details

I. General information

NPI: 1285934406
Provider Name (Legal Business Name): MANDY L JAMES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANDY L BLUMER PA-C

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12345 SW HORIZON BLVD STE 57
BEAVERTON OR
97007-9475
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-8820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61243759
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA161600
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: