Provider Demographics
NPI:1710724273
Name:VAN MAREN, TIFFANY ANNE (CPM, LDM, LM, THW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANNE
Last Name:VAN MAREN
Suffix:
Gender:F
Credentials:CPM, LDM, LM, THW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-8227
Mailing Address - Country:US
Mailing Address - Phone:707-218-4323
Mailing Address - Fax:541-787-6140
Practice Address - Street 1:937 CHETCO AVE STE I
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-2562
Practice Address - Country:US
Practice Address - Phone:541-254-9101
Practice Address - Fax:541-787-6140
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR113468374J00000X
ORDEM-LD-10245512176B00000X
CALM744176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula