MEDICARE: JACQLYN RIEMERSMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207V00000X	Obstetrics & Gynecology Physician	35151578	OH

General Provider Information

NPI Number	:	1073140653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQLYN RIEMERSMA

Provider Business Mailing Address
First Line	:	2139 AUBURN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2906
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7545 BEECHMONT AVE STE B
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-4238
Country	:	US
Telephone Number	:	513-564-1600
Fax Number	:	513-564-4001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	09/11/2024

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Directions to “ JACQLYN RIEMERSMA ” Practice Location

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