Healthcare Provider Details

I. General information

NPI: 1538558762
Provider Name (Legal Business Name): MARLEY ROSEANNE ABRAMS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARLEY MITCHELL

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 NE 139TH ST STE 270
VANCOUVER WA
98686-2719
US

IV. Provider business mailing address

PO BOX 4825
PORTLAND OR
97208-4825
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-2778
  • Fax:
Mailing address:
  • Phone: 360-882-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME00078800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberLK-0000176
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number201900886NP
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP60949950
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0043359
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: