Individual
KATHERINE D. KETTERHAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3200 E RACINE ST, JANESVILLE, WI 53546-2343
(608) 371-8000
(608) 371-8008
Mailing address
1446 N RANDALL AVE, JANESVILLE, WI 53545-1122
(608) 758-7215
(608) 758-3216
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1757-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41992300
—
WI
01
—
61167
DEAN HEALTH SYSTEMS, INC
WI
Enumeration date
11/16/2006
Last updated
11/03/2020
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