Healthcare Provider Details

I. General information

NPI: 1174594436
Provider Name (Legal Business Name): DAVID LAWRENCE NEWMAN M.S.N., C.F.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5849 NE SANDY BLVD
PORTLAND OR
97213-3435
US

IV. Provider business mailing address

2349 NE 16TH AVE
PORTLAND OR
97212-4227
US

V. Phone/Fax

Practice location:
  • Phone: 503-251-8876
  • Fax:
Mailing address:
  • Phone: 503-282-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number090006310N1FNPPP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: