Healthcare Provider Details

I. General information

NPI: 1871760769
Provider Name (Legal Business Name): JOANNE SUE KEELER-ROBERTS CN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2008
Last Update Date: 05/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 MANITOU AVE
MANITOU SPRINGS CO
80829-2910
US

IV. Provider business mailing address

1107 MANITOU AVE
MANITOU SPRINGS CO
80829-2910
US

V. Phone/Fax

Practice location:
  • Phone: 719-650-4584
  • Fax: 719-687-8055
Mailing address:
  • Phone: 719-650-4584
  • Fax: 719-687-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number611510
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number611510
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: