Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 01083558A | IN |
Y | 207V00000X | Obstetrician & Gynecologist | 35.095325 | OH |
N | 207V00000X | Obstetrician & Gynecologist | 46698 | KY |
NPI | 1003079575 |
---|---|
Provider Name | Carrie Cooper-Fenske Sanan |
First Address | Cincinnati, OH 45206-1785 |
Second Address | Wilmington, OH 45177-2123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2008 |
Last Update Date | 08/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0070900 | (05) | OH |
7100211040 | (05) | KY |