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Organization
DEBRA KETTLESON INC
Active
Organization
DEBRA KETTLESON INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA LYNN KETTLESON (OWNER/PROVIDER)
(808) 365-5988
Entity
Organization
Contact information
Practice address
670 PONAHAWAI ST STE 221, HILO, HI 96720-7829
(808) 365-5988
(808) 365-5989
Mailing address
670 PONAHAWAI ST STE 221, HILO, HI 96720-7829
(808) 365-5988
(808) 365-5989
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0381075
HI
207QG0300X
Geriatric Medicine (Family Medicine) Physician
2009004214
HI
Other
Enumeration date
11/12/2014
Last updated
01/05/2015
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