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Individual

SEDRA JO KETCHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
615 N MICHIGAN ST, 1ST FL HOSPITALIST STE, SOUTH BEND, IN 46601-1033
(574) 647-3050
Mailing address
3245 HEALTH DRIVE, SUITE 100, GRANGER, IN 46530-3245
(574) 647-1840

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
2014013264
MO
363LA2200X
Adult Health Nurse Practitioner
Primary
71010526A
IN
363LG0600X
Gerontology Nurse Practitioner
2014013264
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300044987
IN
05
7100256130
KY
Enumeration date
02/21/2013
Last updated
05/01/2023
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