Individual
JENNIFER L MICEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
530 NW 27TH ST, CORVALLIS, OR 97330-5223
(541) 766-6835
(541) 766-6186
Mailing address
530 NW 27TH ST, CORVALLIS, OR 97330-5223
(541) 766-6835
(541) 766-6186
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO25970
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168395
—
OR
01
—
R103163
MEDICARE PART B
—
Enumeration date
02/08/2006
Last updated
12/18/2024
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