Provider Demographics
NPI:1699950683
Name:KELLER, STEPHANIE E (RN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:KELLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4953 STATE ROUTE 39
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-9739
Mailing Address - Country:US
Mailing Address - Phone:419-565-0406
Mailing Address - Fax:
Practice Address - Street 1:4953 STATE ROUTE 39
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:OH
Practice Address - Zip Code:44827-9739
Practice Address - Country:US
Practice Address - Phone:419-565-0406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN326698163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse