Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 30.026248 | OH |
N | 1223G0001X | General Practice | 28791 | TX |
N | 213EG0000X | General Practice | 28791 | TX |
NPI | 1003180092 |
---|---|
Provider Name | Dr. Krista Whalen Nall |
First Address | Hamilton, OH 45013-3433 |
Second Address | Fairfield, OH 45014-5369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2012 |
Last Update Date | 18/08/2020 |