Provider Demographics
NPI:1972896553
Name:KELLER, MARY ANN (RN)
Entity type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
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 1:520 6TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2705
Mailing Address - Country:US
Mailing Address - Phone:703-402-3728
Mailing Address - Fax:
Practice Address - Street 1:520 6TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2705
Practice Address - Country:US
Practice Address - Phone:703-402-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1008097163W00000X
VA0001112422163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse