Individual
JACLYN NOTARBERARDINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1135 W UNIVERSITY DR STE 450, ROCHESTER, MI 48307-1871
(248) 650-1871
Mailing address
18901 LAKE SHORE BLVD, EUCLID, OH 44119-1078
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
50.007801
OH
363A00000X
Physician Assistant
Primary
5601011240
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/24/2021
Last updated
12/05/2024
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