Provider Demographics
NPI:1497844484
Name:OWEN, TAMARA (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:
Last Name:OWEN
Suffix:
Gender:F
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:PO BOX 820134
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97282-1134
Mailing Address - Country:US
Mailing Address - Phone:503-788-7726
Mailing Address - Fax:503-788-7729
Practice Address - Street 1:1924 NE COUCH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3023
Practice Address - Country:US
Practice Address - Phone:503-788-7726
Practice Address - Fax:503-788-7729
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000565Medicaid
OR000565Medicaid
ORS76920Medicare UPIN