| NPI | 1821642646 |
|---|---|
| Former Name | BROOKE MARIE KETELSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: IA A154100) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: IA A154200) |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2019-10-07 |