Healthcare Provider Details

I. General information

NPI: 1093701757
Provider Name (Legal Business Name): LISA ERIN KEEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST HALSTED 600
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

1101 SAM PERRY BLVD., SUITE 211
FREDERICKSBURG VA
22401
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5353
  • Fax:
Mailing address:
  • Phone: 540-372-7792
  • Fax: 540-372-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024165085
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: