Individual
KETEVAN SHONIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3333 E MAIN ST, MERRILL, WI 54452-8959
(715) 539-5600
Mailing address
3333 E MAIN ST, MERRILL, WI 54452-8959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/20/2023
Last updated
09/03/2025
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