Basic Information
| Provider Information | |||||||||
| NPI: | 1598261604 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KETZNER | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7845 W 274TH ST | ||||||||
| Address2: | |||||||||
| City: | LOUISBURG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660535205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137315037 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1318 KANSAS DR | ||||||||
| Address2: | |||||||||
| City: | PAOLA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135575678 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2018 | ||||||||
| LastUpdateDate: | 05/22/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 53-78196 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.