Individual
MRS. JENNIFER LYNN MIDTLIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
5300 FAR HILLS AVE, DAYTON, OH 45429-2381
(937) 433-7536
(937) 433-9612
Mailing address
1016 PAXON DR, BELLBROOK, OH 45305-8948
(937) 938-0136
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN260615
OH
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
11935-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000745200
ANTHEM BCBS OH
OH
05
—
0058747
—
OH
01
—
421534506186
CARESOURCE OHIO
OH
01
—
9328817
AETNA
OH
01
—
P01005063
RR MEDICARE
OH
Enumeration date
10/13/2010
Last updated
08/03/2016
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