Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO2463 | ME |
Y | 207Q00000X | Family Doctor | DO2463 | ME |
NPI | 1467726224 |
---|---|
Provider Name | Danae W Kershner |
First Address | Brewer, ME 04412-1005 |
Second Address | Bangor, ME 04401-3053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2012 |
Last Update Date | 13/07/2015 |