Provider Demographics
NPI:1093132417
Name:KERNEN, SANDRA (ED S)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:KERNEN
Suffix:
Gender:F
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 W RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44444-8403
Mailing Address - Country:US
Mailing Address - Phone:330-841-2321
Mailing Address - Fax:
Practice Address - Street 1:105 HIGH ST NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-1219
Practice Address - Country:US
Practice Address - Phone:330-841-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist