Provider Demographics
NPI:1629854575
Name:KETCHAYA, CECILE NONO
Entity Type:Individual
Prefix:
First Name:CECILE
Middle Name:NONO
Last Name:KETCHAYA
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 1:12801 137TH AVE N
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:55327-7504
Mailing Address - Country:US
Mailing Address - Phone:651-233-9059
Mailing Address - Fax:
Practice Address - Street 1:12801 137TH AVE N
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:MN
Practice Address - Zip Code:55327-7504
Practice Address - Country:US
Practice Address - Phone:651-233-9059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2457517163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse