Individual
JORDAN ALEXANDER NILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
805 SE 151ST AVE, PORTLAND, OR 97233-2916
(971) 271-7270
Mailing address
333 NE 146TH AVE APT 210, PORTLAND, OR 97230-4273
(503) 753-3194
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
1245624253
OR
Other
Enumeration date
03/05/2019
Last updated
03/05/2019
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