Individual
KETRAH DEKANICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-0001
(253) 968-0117
Mailing address
9040 JACKSON AVE, TACOMA, WA 98431-0001
(253) 968-0117
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
Other
Enumeration date
02/03/2025
Last updated
02/03/2025
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