Individual
LELISA HIKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2700 NE 17TH ST, GRESHAM, OR 97030-4406
(813) 407-3430
Mailing address
2700 NE 17TH ST, GRESHAM, OR 97030-4406
(813) 407-3430
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
202000195RN
OR
163WC1500X
Community Health Registered Nurse
Primary
202000195RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000
I DON'T HAVE THEM
—
Enumeration date
02/06/2020
Last updated
02/06/2020
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