Provider Demographics
NPI:1750962825
Name:KETTER, LADEANA ANN (RN)
Entity type:Individual
Prefix:
First Name:LADEANA
Middle Name:ANN
Last Name:KETTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LADEANA
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN KETTER
Mailing Address - Street 1:532 W RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-5547
Mailing Address - Country:US
Mailing Address - Phone:757-593-6307
Mailing Address - Fax:
Practice Address - Street 1:532 W RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-5547
Practice Address - Country:US
Practice Address - Phone:757-593-6307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001267615163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse