Provider Demographics
NPI:1629700984
Name:BEAMAN, PETER JAY (RN)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JAY
Last Name:BEAMAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9707 N CLARENDON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-1917
Mailing Address - Country:US
Mailing Address - Phone:503-849-8320
Mailing Address - Fax:
Practice Address - Street 1:8638 N LOMBARD ST STE 3A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-3741
Practice Address - Country:US
Practice Address - Phone:503-386-1972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
OR201041505163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No163WE0003XNursing Service ProvidersRegistered NurseEmergency