Provider Demographics
NPI:1407308117
Name:KETCHUM, ERICA DANIELLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:DANIELLE
Last Name:KETCHUM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:KIETZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4420 E 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6517
Mailing Address - Country:US
Mailing Address - Phone:219-617-9089
Mailing Address - Fax:
Practice Address - Street 1:3903 E US HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5810
Practice Address - Country:US
Practice Address - Phone:219-736-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28167043A363L00000X
IN71006700A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner