Provider Demographics
NPI:1487940813
Name:KETTMANN, MEGAN ASHLEY (RN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ASHLEY
Last Name:KETTMANN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ASHLEY
Other - Last Name:ROSSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3851 ROSECRANS ST
Mailing Address - Street 2:SUITE 715
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3134
Mailing Address - Country:US
Mailing Address - Phone:619-692-8499
Mailing Address - Fax:858-715-6458
Practice Address - Street 1:3851 ROSECRANS ST
Practice Address - Street 2:SUITE 715
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3134
Practice Address - Country:US
Practice Address - Phone:619-692-8499
Practice Address - Fax:858-715-6458
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA591779163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health