Healthcare Provider Details

I. General information

NPI: 1003727504
Provider Name (Legal Business Name): LORI ANN KETTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E MAIN ST STE 370
AUBURN WA
98002-4905
US

IV. Provider business mailing address

1 E MAIN ST STE 370
AUBURN WA
98002-4905
US

V. Phone/Fax

Practice location:
  • Phone: 253-545-5800
  • Fax: 253-833-9944
Mailing address:
  • Phone: 253-545-5800
  • Fax: 253-833-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN60061216
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: