Provider Demographics
NPI:1356631055
Name:KETNER, ELIZABETH PITKIN
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PITKIN
Last Name:KETNER
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 1:135 WAVERLY PL
Mailing Address - Street 2:APT 3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3842
Mailing Address - Country:US
Mailing Address - Phone:415-531-1726
Mailing Address - Fax:
Practice Address - Street 1:135 WAVERLY PL
Practice Address - Street 2:APT 3B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3842
Practice Address - Country:US
Practice Address - Phone:415-531-1726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program