MEDICARE: CHRISTIE MARIE KETLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	APRN.CNP.0037950	OH

General Provider Information

NPI Number	:	1871309518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIE MARIE KETLER

Provider Business Mailing Address
First Line	:	1354 WILBUR AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44301-2159
Country	:	US
Telephone Number	:	330-283-5456
Fax Number	:

Provider Business Practice Location Address
First Line	:	1354 WILBUR AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44301-2159
Country	:	US
Telephone Number	:	330-283-5456
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2024
Last Update Date	:	12/07/2024

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