Individual
REBECCA L KETTERHAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1726 SHAWANO AVE, GREEN BAY, WI 54303-3216
(920) 429-1700
(920) 830-5970
Mailing address
1726 SHAWANO AVE, GREEN BAY, WI 54303-3216
(920) 429-1700
(920) 830-5970
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4227
WI
Other
Enumeration date
10/19/2017
Last updated
03/23/2022
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