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Individual

MS. MARTHA L KETTERIDGE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
N.P

Contact information

Practice address
210 E MAIN ST, STE 5, HUNTINGTON, NY 11743-2979
(631) 864-1795
(631) 864-1795
Mailing address
210 E MAIN ST, STE 5, HUNTINGTON, NY 11743-2979
(631) 864-1795
(631) 864-1795

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
F400635
FL
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
F400635
NY

Other

Enumeration date
11/01/2006
Last updated
03/08/2019
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