Licina, Jelena A

Licina, Jelena A is an individual health care provider with primary practice located at 1575 Beam Ave , Maplewood MN 55109-1126. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Licina, Jelena A can be contacted via phone (651) 232-2000.

Contact Information

Primary practice address
1575 Beam Ave Maplewood MN 55109-1126
Phone: (651) 232-2000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 73953 Minnesota
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X ME 88772 Florida
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 50835 Colorado

Profile Details

NPI number 1316921687
LBN Legal business name Licina, Jelena A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 1st, 2005
Last updated May 15th, 2024 - about 4 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316921687 NPPES
Florida MEDICAID 268901400
Florida MEDICAID 59135727
Florida Other 029545

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