MEDICARE: SUZANNE KELLER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	CRNA1207	AZ

General Provider Information

NPI Number	:	1184099350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE KELLER CRNA

Provider Business Mailing Address
First Line	:	7301 N 16TH ST STE 102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-5266
Country	:	US
Telephone Number	:	480-420-4027
Fax Number	:	602-535-0940

Provider Business Practice Location Address
First Line	:	6442 E SPEEDWAY BLVD STE 152
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-0013
Country	:	US
Telephone Number	:	520-771-8175
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2015
Last Update Date	:	02/03/2025

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