Provider Demographics
NPI:1356018659
Name:KETTERING, CHEYENNE
Entity Type:Individual
Prefix:MRS
First Name:CHEYENNE
Middle Name:
Last Name:KETTERING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 LONE PINE DR SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-8404
Mailing Address - Country:US
Mailing Address - Phone:507-993-5215
Mailing Address - Fax:
Practice Address - Street 1:1315 LONE PINE DR SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-8404
Practice Address - Country:US
Practice Address - Phone:507-993-5215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife