Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | G9015 | TX |
NPI | 1093828733 |
---|---|
Provider Name | Kathleen Marie Wolner |
First Address | Dayton, OH 45428-9000 |
Second Address | Dayton, OH 45428-9000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |