Provider Demographics
NPI:1962480509
Name:TITCHENER, LAUREN MARY (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MARY
Last Name:TITCHENER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:MARY
Other - Last Name:OLAFSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1776 SW MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1715
Mailing Address - Country:US
Mailing Address - Phone:971-386-2278
Mailing Address - Fax:503-224-4494
Practice Address - Street 1:3750 CHEMAWA RD NE
Practice Address - Street 2:CHEMAWA INDIAN HEALTH CENTER
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1111
Practice Address - Country:US
Practice Address - Phone:503-304-7600
Practice Address - Fax:503-304-7677
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2007-0710207Q00000X
NC200200615207Q00000X
ORMD153935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500640996Medicaid
8HE508Medicare ID - Type Unspecified
G24176Medicare UPIN