Provider Demographics
NPI:1962123489
Name:KELLER, ELIZABETH LYNN (RN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LYNN
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 1:5319 W HARVARD DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8193
Mailing Address - Country:US
Mailing Address - Phone:414-412-0743
Mailing Address - Fax:
Practice Address - Street 1:5319 W HARVARD DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8193
Practice Address - Country:US
Practice Address - Phone:414-412-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134825-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse