Provider Demographics
NPI:1720091655
Name:FLAGE, CARYN PATRICIA
Entity Type:Individual
Prefix:MISS
First Name:CARYN
Middle Name:PATRICIA
Last Name:FLAGE
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 1:4705 BLUEBERRY AVE NW
Mailing Address - Street 2:APT 77
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-1312
Mailing Address - Country:US
Mailing Address - Phone:419-575-5723
Mailing Address - Fax:
Practice Address - Street 1:4705 BLUEBERRY AVE NW
Practice Address - Street 2:APT 77
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-1312
Practice Address - Country:US
Practice Address - Phone:419-575-5723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2659430Medicaid