Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 34-012610 | OH |
NPI | 1003158494 |
---|---|
Provider Name | Jaclyn Flickinger |
First Address | Tallmadge, OH 44278 |
Second Address | Tallmadge, OH 44278-1809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2013 |
Last Update Date | 17/03/2018 |