Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | AG07180062 | OH |
NPI | 1164918322 |
---|---|
Provider Name | Sharla N Cantrell |
First Address | Beavercreek, OH 45434-6282 |
Second Address | Dayton, OH 45424-1049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2018 |
Last Update Date | 10/07/2018 |