Healthcare Provider Details

I. General information

NPI: 1558404418
Provider Name (Legal Business Name): SUSAN MARIE KERN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1898
US

IV. Provider business mailing address

7530 NEW LONDON CIR
CENTERVILLE FINANCE OH
45459-5058
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3543
  • Fax:
Mailing address:
  • Phone: 937-433-0478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number141334
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: