Healthcare Provider Details

I. General information

NPI: 1851948699
Provider Name (Legal Business Name): NICOLE MARIE KEELING WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4254 W ORCHID LN
CHANDLER AZ
85226-7246
US

IV. Provider business mailing address

4254 W ORCHID LN
CHANDLER AZ
85226-7246
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone: 888-731-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number230014
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: