Provider Demographics
NPI:1356566517
Name:DURHAM, MARY JANE (CPM,LDM)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:DURHAM
Suffix:
Gender:F
Credentials:CPM,LDM
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JANE
Other - Last Name:CROWDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LDM, CPM
Mailing Address - Street 1:181 UPPER APPLEGATE RD # 273
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9739
Mailing Address - Country:US
Mailing Address - Phone:541-899-3967
Mailing Address - Fax:
Practice Address - Street 1:9400 HIGHWAY 238
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-9554
Practice Address - Country:US
Practice Address - Phone:541-226-7061
Practice Address - Fax:541-899-9027
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEMLD10115742175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay