Provider Demographics
NPI:1467883702
Name:ANDERSON, MARINA L (CPM LDM)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CPM LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26170 SW CANYON CREEK RD
Mailing Address - Street 2:APT 102
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7667
Mailing Address - Country:US
Mailing Address - Phone:503-516-5261
Mailing Address - Fax:
Practice Address - Street 1:26170 SW CANYON CREEK RD
Practice Address - Street 2:APT 102
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7667
Practice Address - Country:US
Practice Address - Phone:503-516-5261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10157706176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife