Individual
IAN THOMAS DRAKULICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
8517 SE 17TH AVE, PORTLAND, OR 97202-7347
(503) 542-4800
(503) 542-4801
Mailing address
2925 SE 87TH AVE, PORTLAND, OR 97266-1594
(971) 303-1616
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201230436LPN
OR
Other
Enumeration date
10/29/2018
Last updated
10/29/2018
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