Provider Demographics
NPI:1659975886
Name:SCHMIESING, JACLYN SUE
Entity Type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:SUE
Last Name:SCHMIESING
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 1:13836 AILES RD
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:OH
Mailing Address - Zip Code:45302-9754
Mailing Address - Country:US
Mailing Address - Phone:937-726-9840
Mailing Address - Fax:
Practice Address - Street 1:13836 AILES RD
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:OH
Practice Address - Zip Code:45302-9754
Practice Address - Country:US
Practice Address - Phone:937-726-9840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant