Provider Demographics
NPI:1679242796
Name:FLINT, JANNIFER R (LPN)
Entity Type:Individual
Prefix:
First Name:JANNIFER
Middle Name:R
Last Name:FLINT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-2446
Mailing Address - Country:US
Mailing Address - Phone:937-371-2859
Mailing Address - Fax:
Practice Address - Street 1:730 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-2446
Practice Address - Country:US
Practice Address - Phone:937-371-2859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140256364SX0204X, 364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care MedicineGroup - Multi-Specialty
No364SX0204XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology, PediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLPN140256MEDS-IVOtherNURSE
OH140256OtherNURSE