Provider Demographics
NPI:1992033450
Name:VINSON, JAMES LEO (BSN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEO
Last Name:VINSON
Suffix:
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9492 SW MAPLEWOOD DR
Mailing Address - Street 2:APARTMENT D41
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6157
Mailing Address - Country:US
Mailing Address - Phone:503-936-0376
Mailing Address - Fax:
Practice Address - Street 1:16485 SW PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-3446
Practice Address - Country:US
Practice Address - Phone:503-620-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-21
Last Update Date:2009-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200840470RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse