Provider Demographics
NPI:1922056498
Name:KERSTETTER, MOLLY ELIZABETH (CNM)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:KERSTETTER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:MILCETICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1 PARK WEST BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-4219
Mailing Address - Country:US
Mailing Address - Phone:330-869-9777
Mailing Address - Fax:330-869-0052
Practice Address - Street 1:1 PARK WEST BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4219
Practice Address - Country:US
Practice Address - Phone:330-869-9777
Practice Address - Fax:330-869-0052
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM08827367A00000X
OHNM-08827367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2750563Medicaid