Provider Demographics
NPI:1639553373
Name:LACHMILLER, JACLYN
Entity Type:Individual
Prefix:MISS
First Name:JACLYN
Middle Name:
Last Name:LACHMILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 HARROUN RD STE 304
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2146
Mailing Address - Country:US
Mailing Address - Phone:419-824-1100
Mailing Address - Fax:419-824-1771
Practice Address - Street 1:5300 HARROUN RD STE 304
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2146
Practice Address - Country:US
Practice Address - Phone:419-824-1100
Practice Address - Fax:419-824-1771
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17632-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily