Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 40131 | IA |
NPI | 1225389513 |
---|---|
Provider Name | Dr. Susan C Mckernan |
First Address | Iowa City, IA 52242-1192 |
Second Address | Iowa City, IA 52242-1001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2012 |
Last Update Date | 26/09/2012 |