Healthcare Provider Details

I. General information

NPI: 1811272453
Provider Name (Legal Business Name): BONNIE KELLER ALVEY CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-4060
  • Fax: 504-842-3947
Mailing address:
  • Phone: 504-842-2481
  • Fax: 504-842-3497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAP06661
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: