Healthcare Provider Details

I. General information

NPI: 1679242796
Provider Name (Legal Business Name): JANNIFER R FLINT LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2021
Last Update Date: 09/11/2021
Certification Date: 09/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 E CENTRAL AVE
MIAMISBURG OH
45342-2446
US

IV. Provider business mailing address

730 E CENTRAL AVE
MIAMISBURG OH
45342-2446
US

V. Phone/Fax

Practice location:
  • Phone: 937-371-2859
  • Fax:
Mailing address:
  • Phone: 937-371-2859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number140256
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code364SX0204X
TaxonomyPediatric Oncology Clinical Nurse Specialist
License Number140256
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: