Provider Demographics
NPI:1003130584
Name:KETTLEHAKE, DAWN EVE (RN)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:EVE
Last Name:KETTLEHAKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 W JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-7926
Mailing Address - Country:US
Mailing Address - Phone:937-602-5893
Mailing Address - Fax:
Practice Address - Street 1:2910 W JACKSON RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-7926
Practice Address - Country:US
Practice Address - Phone:937-602-5893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN277114163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health