Provider Demographics
NPI:1699231621
Name:KEITZ, LYNN (FNP-C)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:
Last Name:KEITZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:SANTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:360 EAST 7TH STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-920-9123
Mailing Address - Fax:909-920-6019
Practice Address - Street 1:360 EAST 7TH STREET
Practice Address - Street 2:SUITE D
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-920-9123
Practice Address - Fax:909-920-6019
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009387363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily