Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 17591 | OH |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 17591 | OH |
NPI | 1033516240 |
---|---|
Provider Name | Theresa Kern |
First Address | Oakwood, OH 45419-1517 |
Second Address | Dayton, OH 45420-1890 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2014 |
Last Update Date | 21/02/2020 |