Provider Demographics
NPI:1407915408
Name:NEWMAN, JAMES BEN (PMHNP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BEN
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4676 COMMERCIAL ST SE
Mailing Address - Street 2:PMB 267
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1902
Mailing Address - Country:US
Mailing Address - Phone:503-999-5927
Mailing Address - Fax:
Practice Address - Street 1:1235 WOODROW ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97303-3214
Practice Address - Country:US
Practice Address - Phone:503-999-5427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR084053069N6 PMHNP-PP363LP0808X
OR163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR056080Medicaid
ORS09414Medicare UPIN