Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO00000470 | WA |
NPI | 1063584498 |
---|---|
Provider Name | Dr. Deborah Jean Ketterer |
First Address | Renton, WA 98055-6226 |
Second Address | Renton, WA 98055-6226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1106186 | (05) | WA |
U21759 | (02) |