| Doctor Name: | MARK KETCHUM |
| NPI Number: | 1043456007 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | R.N. |
| License Number: | 176755 |
| Business Practice Address: | 3061 E 109th Ave Northglenn, CO - 802335475 |
| Business Phone Number: | 7202710628 |
| Business Fax Number: | 3039531217 |
| Mailing Address: | 3061 E 109th Ave, NORTHGLENN |
| State: | CO |
| Postal Code: | 802335475 |
| Phone Number: | 7202710628 |
| Fax Number: | 3039531217 |
| NPI Enumeration Date: | 12/22/2008 |
| NPI Last Update Date: | 12/22/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WH0200X |
| License Number: | 176755 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Home Health |
| Taxonomy Definition: | |