Healthcare Provider Details

I. General information

NPI: 1063491231
Provider Name (Legal Business Name): AMANDA EILEEN KEEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA EILEEN MOHLER M.D.

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N CURTIS RD SUITE 202
BOISE ID
83706-1337
US

IV. Provider business mailing address

1000 N CURTIS RD SUITE 202
BOISE ID
83706-1337
US

V. Phone/Fax

Practice location:
  • Phone: 208-377-3435
  • Fax: 208-377-3147
Mailing address:
  • Phone: 208-377-3435
  • Fax: 208-377-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number45799
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number23709
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number37126
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberM-12757
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: