Healthcare Provider Details

I. General information

NPI: 1982979514
Provider Name (Legal Business Name): LORRIE KELLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 664
BOX ELDER MT
59521-9797
US

IV. Provider business mailing address

RR 1 BOX 664
BOX ELDER MT
59521-9797
US

V. Phone/Fax

Practice location:
  • Phone: 406-395-4486
  • Fax:
Mailing address:
  • Phone: 406-395-4486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number32555
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: