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Jordan Licata
Student in an Organized Health Care Education/Training Program in Lebanon, Oregon
NPI 1952795106

Jordan Licata is a Student in an Organized Health Care Education/Training Program based in Lebanon, OR. Jordan Licata practices in Lebanon, OR. The NPI Number for Jordan Licata is 1952795106 and holds a License No. (Oregon).

The current practice location address for Jordan Licata is 200 Mullins Dr, Lebanon, OR and can be reached out via phone at 541-259-0200. You can also correspond with Jordan Licata through the mailing address at 200 MULLINS DR, LEBANON, OR - 97355-3983 (mailing address contact number: ).

Location: 200 Mullins Dr, Lebanon, OR, 97355-3983
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1952795106
Provider Name
Jordan Licata
Credential
Provider Entity Type
Individual
Gender
Male
Address
200 Mullins Dr, Lebanon, OR, 97355-3983
Phone Number
541-259-0200
Fax Number
Provider Enumeration Date
03/26/2015
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
200 Mullins Dr
City
Lebanon
State
Oregon
Zip
97355-3983
Phone Number
541-259-0200
Fax Number
person
Provider Business Mailing Address Details
Address
200 Mullins Dr
City
Lebanon
State
Oregon
Zip
97355-3983
Phone Number
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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