Provider Demographics
NPI:1386907517
Name:KEISE, RUBENA (APN)
Entity type:Individual
Prefix:
First Name:RUBENA
Middle Name:
Last Name:KEISE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 TILLOU RD W
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1357
Mailing Address - Country:US
Mailing Address - Phone:732-331-7797
Mailing Address - Fax:732-544-0474
Practice Address - Street 1:19445 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3361
Practice Address - Country:US
Practice Address - Phone:313-307-0088
Practice Address - Fax:313-281-2235
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00382500363LA2200X
MI4704317076363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health