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Individual

KETURA WANLESS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN, PHN

Contact information

Practice address
514 RIVERVIEW AVE, WAUKESHA, WI 53188-3631
(262) 548-8472
Mailing address
514 RIVERVIEW AVE, WAUKESHA, WI 53188-3631
(262) 548-8472

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
222215-30
WI

Other

Enumeration date
02/24/2016
Last updated
02/24/2016
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