Individual
MS. ELLEN MARIE KETTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3522 W LISBON AVE, MILWAUKEE, WI 53208-1953
(414) 935-8000
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-6850
(414) 805-6851
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3840 - 23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942653480
—
WI
Enumeration date
07/20/2016
Last updated
04/22/2020
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