Provider Demographics
NPI:1902353410
Name:FLAGG, SALISA
Entity Type:Individual
Prefix:MRS
First Name:SALISA
Middle Name:
Last Name:FLAGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 W BELMAR PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-1018
Mailing Address - Country:US
Mailing Address - Phone:513-379-2191
Mailing Address - Fax:
Practice Address - Street 1:1610 W BELMAR PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-1018
Practice Address - Country:US
Practice Address - Phone:513-379-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN315930163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse