Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DN012237 | GA |
NPI | 1114004579 |
---|---|
Provider Name | Dr. Mikelle Louella Kernig |
First Address | Beavercreek, OH 45434-5678 |
Second Address | Wright Patterson Afb, OH 45433-5546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |