Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | C10004829 | DE |
NPI | 1063497709 |
---|---|
Provider Name | Renee Kottenhahn |
First Address | Wilmington, DE 19805-7170 |
Second Address | Wilmington, DE 19801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 07/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G61699 | (02) |