Provider Demographics
NPI:1396272894
Name:MARSH, DAVID BRANDENBURG (NP-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRANDENBURG
Last Name:MARSH
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W UMPQUA ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2952
Mailing Address - Country:US
Mailing Address - Phone:865-719-6702
Mailing Address - Fax:541-464-7106
Practice Address - Street 1:525 W UMPQUA ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2952
Practice Address - Country:US
Practice Address - Phone:541-464-7141
Practice Address - Fax:541-464-7106
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005143363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health