Provider Demographics
NPI:1932737731
Name:FLAREY, DOMINICK LAWRENCE (NP)
Entity Type:Individual
Prefix:MR
First Name:DOMINICK
Middle Name:LAWRENCE
Last Name:FLAREY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1477 TRIPODI CIR
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-3564
Mailing Address - Country:US
Mailing Address - Phone:330-307-5877
Mailing Address - Fax:330-652-7575
Practice Address - Street 1:2400 NILES CORTLAND RD SE STE 4
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-3869
Practice Address - Country:US
Practice Address - Phone:330-652-7776
Practice Address - Fax:330-652-7575
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-29
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.03531363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty