| Doctor Name: | ADDIE NOEL KETELSEN |
| NPI Number: | 1043519499 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | A-113254 |
| Business Practice Address: | 7231 Sunwood Dr Nw Anoka, MN - 553035190 |
| Business Phone Number: | 7632360000 |
| Business Fax Number: | |
| Mailing Address: | 2925 Chicago Ave, MINNEAPOLIS |
| State: | MN |
| Postal Code: | 554071321 |
| Phone Number: | 6122625000 |
| Fax Number: | |
| NPI Enumeration Date: | 03/24/2011 |
| NPI Last Update Date: | 09/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | A-113254 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |