Individual
JODI LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2600 SE 170TH AVE, PORTLAND, OR 97236-1213
(971) 201-0209
Mailing address
2600 SE 170TH AVE, PORTLAND, OR 97236-1213
(971) 201-0209
Taxonomy
Speciality
Code
Description
License number
State
282E00000X
Long Term Care Hospital
Primary
548388
OR
Other
Enumeration date
06/08/2016
Last updated
06/08/2016
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