Individual
ELIZABETH ANN KETNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.H.S., MD
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1341
Mailing address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1341
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD452066
PA
207R00000X
Internal Medicine Physician
MT201911
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/02/2010
Last updated
04/20/2016
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