Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 34.013051 | OH |
NPI | 1497701890 |
---|---|
Provider Name | Dr. Ann Laura Habenicht |
First Address | Beavercreek, OH 45431-3820 |
Second Address | Beavercreek, OH 45431 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 12/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C45853 | (02) | IL |