Provider Demographics
NPI:1417645334
Name:MARSH, AUDRA MICHELLE (BS, MSCN)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:MICHELLE
Last Name:MARSH
Suffix:
Gender:F
Credentials:BS, MSCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 NE FERN AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1130
Mailing Address - Country:US
Mailing Address - Phone:971-279-2728
Mailing Address - Fax:971-209-7746
Practice Address - Street 1:333 BUSH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4127
Practice Address - Country:US
Practice Address - Phone:971-279-2728
Practice Address - Fax:971-209-7746
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist