Healthcare Provider Details

I. General information

NPI: 1972675031
Provider Name (Legal Business Name): MRS. PATRICIA ELLEN KEATON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31317 N BLACKFOOT DR
QUEEN CREEK AZ
85243
US

IV. Provider business mailing address

31317 N BLACKFOOT DR
QUEEN CREEK AZ
85243
US

V. Phone/Fax

Practice location:
  • Phone: 480-726-2166
  • Fax:
Mailing address:
  • Phone: 480-726-2166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: