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KETURA ISIDORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
64 BLUFFTON RD, BLUFFTON, SC 29910-7621
(317) 442-9799
Mailing address
PO BOX 749306, ATLANTA, GA 30374-9306
(317) 442-9799

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1943
SC
363AM0700X
Medical Physician Assistant
10001501A
IN

Other

Enumeration date
03/12/2013
Last updated
11/03/2024
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