Provider Demographics
NPI:1841493988
Name:MARSHALL-OLSON, ANGELA TRISSANDRA (DO)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:TRISSANDRA
Last Name:MARSHALL-OLSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:TRISSANDRA
Other - Last Name:MARKHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 NW 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2906
Mailing Address - Country:US
Mailing Address - Phone:503-413-7074
Mailing Address - Fax:503-413-6769
Practice Address - Street 1:1200 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2906
Practice Address - Country:US
Practice Address - Phone:503-413-7074
Practice Address - Fax:503-413-6769
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO29017207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OROTH000Medicare UPIN