Healthcare Provider Details

I. General information

NPI: 1679697650
Provider Name (Legal Business Name): WILHELMINA KEELING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 EAST SEVEN MILE DETROIT HEALTH DEPT. - NORTHEAST HEALTH CENTER
DETROIT MI
48234
US

IV. Provider business mailing address

1525 CHERBONEAU PL #18B
DETROIT MI
48207-2842
US

V. Phone/Fax

Practice location:
  • Phone: 313-852-4243
  • Fax: 313-876-0177
Mailing address:
  • Phone: 313-842-1491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number4704099286
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: