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General NPI Number Information
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NPI Number | 1407308117
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Entity Type | Individual
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Provider Name | ERICA DANIELLE KETCHUM FNP
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Gender | Female
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 3903 E US HIGHWAY 30
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5810
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Country | US
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Telephone | 219-736-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 4420 E 61ST AVE
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City | HOBART
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State | IN
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Zip | 46342-6517
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Country | US
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Telephone | 219-617-9089
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 28167043A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71006700A
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License Number State | IN
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