Individual
ELIZABETH NICOLE TYLER-JIMENEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
929 NW GRANT AVE, CORVALLIS, OR 97330-4503
(541) 754-1023
Mailing address
929 NW GRANT AVE, CORVALLIS, OR 97330-4503
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BL100U3L
—
OR
Enumeration date
02/25/2010
Last updated
02/25/2010
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