Healthcare Provider Details

I. General information

NPI: 1710724273
Provider Name (Legal Business Name): TIFFANY ANNE VAN MAREN CPM, LDM, LM, THW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 CHETCO AVE STE I
BROOKINGS OR
97415-2562
US

IV. Provider business mailing address

932 7TH ST
BROOKINGS OR
97415-8227
US

V. Phone/Fax

Practice location:
  • Phone: 541-254-9101
  • Fax: 541-787-6140
Mailing address:
  • Phone: 707-218-4323
  • Fax: 541-787-6140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberDEM-LD-10245512
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM744
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number113468
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: