Healthcare Provider Details

I. General information

NPI: 1396272894
Provider Name (Legal Business Name): DAVID BRANDENBURG MARSH NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W UMPQUA ST
ROSEBURG OR
97471-2952
US

IV. Provider business mailing address

525 W UMPQUA ST
ROSEBURG OR
97471-2952
US

V. Phone/Fax

Practice location:
  • Phone: 541-464-7141
  • Fax: 541-464-7106
Mailing address:
  • Phone: 865-719-6702
  • Fax: 541-464-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberA005143
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: