Healthcare Provider Details

I. General information

NPI: 1356942783
Provider Name (Legal Business Name): CLEO KEPLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4292 BIA RD 2 SOUTH
ST. JOHN ND
58369
US

IV. Provider business mailing address

PO BOX 683
BELCOURT ND
58316-0683
US

V. Phone/Fax

Practice location:
  • Phone: 701-550-9274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: