Provider Demographics
NPI:1982360897
Name:KERSCHNER, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:KERSCHNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MT. VERNON DR.
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566
Mailing Address - Country:US
Mailing Address - Phone:419-260-8982
Mailing Address - Fax:
Practice Address - Street 1:60 MT. VERNON DR.
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43566
Practice Address - Country:US
Practice Address - Phone:419-260-8982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3654238374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0473726Medicaid
OH7749202Medicaid