Individual
MRS. STACIE KETCHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
9040 REID ST, ATTN:MCHJ-CLQ-C, JOINT BASE LEWIS MCCHORD, WA 98431-1100
(253) 968-2252
Mailing address
9040 REID ST, ATTN:MCHJ-CLQ-C, JOINT BASE LEWIS MCCHORD, WA 98431-1100
(253) 968-2252
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP 60538305
WA
Other
Enumeration date
08/17/2015
Last updated
08/17/2015
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