Healthcare Provider Details

I. General information

NPI: 1588328025
Provider Name (Legal Business Name): SUZANNE KELLER ROBERTS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 18TH ST STE 130
COLUMBUS IN
47201-5387
US

IV. Provider business mailing address

PO BOX 775383
CHICAGO IL
60677-5383
US

V. Phone/Fax

Practice location:
  • Phone: 812-379-2020
  • Fax: 812-378-8267
Mailing address:
  • Phone: 812-376-5315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71011841A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: