Individual
DR. KATHERINE REBECCA EXTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
335 GLESSNER AVE, MANSFIELD, OH 44903-2269
(419) 756-2003
Mailing address
840 S WOOD ST STE 820-E, CHICAGO, IL 60612-4325
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036.134806
IL
207RH0003X
Hematology & Oncology Physician
Primary
35131800
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0233087
—
OH
Enumeration date
05/04/2011
Last updated
01/25/2022
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