Provider Demographics
NPI:1124390323
Name:FLINNER, JASON RAY
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:RAY
Last Name:FLINNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1866 BURNETTS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-9743
Mailing Address - Country:US
Mailing Address - Phone:330-466-1333
Mailing Address - Fax:
Practice Address - Street 1:1866 BURNETTS CORNER RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-9743
Practice Address - Country:US
Practice Address - Phone:330-466-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401228500411376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide