Individual
MALLORY LEIGH KETTERER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6675 BUSINESS PKWY STE F, ELKRIDGE, MD 21075-6349
(866) 799-5886
Mailing address
6675 BUSINESS PKWY STE F, ELKRIDGE, MD 21075-6349
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
RN177978
AZ
363LF0000X
Family Nurse Practitioner
Primary
255819
AZ
Other
Enumeration date
11/06/2020
Last updated
08/28/2023
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