Healthcare Provider Details

I. General information

NPI: 1124907472
Provider Name (Legal Business Name): DANA MARTIN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2025
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1937 W HARVARD AVE
ROSEBURG OR
97471-2720
US

IV. Provider business mailing address

2570 NW EDENBOWER BLVD STE 100
ROSEBURG OR
97471-6214
US

V. Phone/Fax

Practice location:
  • Phone: 541-677-7200
  • Fax: 541-229-3309
Mailing address:
  • Phone: 541-677-7200
  • Fax: 541-229-3309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number10060009
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number202008825RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: