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Individual

MS. MALISA KETZNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
8326 WINDSOR MILL RD, BALTIMORE, MD 21244-1112
(734) 772-7704
Mailing address
6144 TRUMPETER LN, YPSILANTI, MI 48197-8729
(734) 772-7704

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703125119
MI

Other

Enumeration date
05/21/2021
Last updated
05/21/2021
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