Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | APRN.CNP.022253 | OH |
NPI | 1073029518 |
---|---|
Provider Name | Kendra A Stanton |
First Address | Bowling Green, OH 43402-1600 |
Second Address | Bowling Green, OH 43402-2664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2017 |
Last Update Date | 03/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0266819 | (05) | OH |
H625540 | MEDICARE (01) | OH |