Provider Demographics
NPI:1164287751
Name:MARJAMA-TAFT, LINDSEY
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:MARJAMA-TAFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 W 58TH ST UNIT 12
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-6511
Mailing Address - Country:US
Mailing Address - Phone:701-799-7941
Mailing Address - Fax:
Practice Address - Street 1:NEUROLOGY AT SALMON CREEK, 2121 N.E. 139TH ST.
Practice Address - Street 2:MEDICAL OFFICE BUILDING A, SUITE 205
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686
Practice Address - Country:US
Practice Address - Phone:360-487-4707
Practice Address - Fax:360-487-4709
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR100068312084N0400X
WAAP615179542084N0400X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology