Provider Demographics
NPI:1285934406
Name:JAMES, MANDY L (PA-C)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:L
Last Name:JAMES
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:L
Other - Last Name:BLUMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12345 SW HORIZON BLVD STE 57
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-9475
Practice Address - Country:US
Practice Address - Phone:503-216-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61243759363A00000X
ORPA161600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500699482Medicaid
ORR187823Medicare PIN
ORR187824Medicare PIN