Individual
ELLEN L KETTERLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1000 HIGHWAY 12, HETTINGER, ND 58639
(701) 567-4561
Mailing address
1100 HIGHWAY 12, HETTINGER, ND 58639-7533
(701) 567-6130
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
5100
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10782
ND BC/BS
—
05
—
14662
—
ND
01
—
33921
SIOUX VALLEY
—
05
—
7705170
—
SD
Enumeration date
10/02/2006
Last updated
07/08/2007
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