Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 35.096376 | OH |
Y | 207R00000X | Internist | 35.096376 | OH |
Y | 111NI0900X | Internist | 35.096376 | OH |
NPI | 1285828863 |
---|---|
Provider Name | Anna Halley Zivkovich |
First Address | Dayton, OH 45459 |
Second Address | Kettering, OH 45429-1221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 21/02/2020 |