Individual
MISS JACLYNN PAULINE BACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1445 W MAIN ST, NEWARK, OH 43055-1989
(513) 834-7063
(513) 873-1567
Mailing address
4600 MONTGOMERY RD STE 400, CINCINNATI, OH 45212-2600
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.313249
OH
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP.13665
OH
Other
Enumeration date
10/03/2012
Last updated
10/03/2024
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