Healthcare Provider Details

I. General information

NPI: 1871939850
Provider Name (Legal Business Name): CYNTHIA L KEISER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 HUGHES DR SUITE 450
TOLEDO OH
43606-3856
US

IV. Provider business mailing address

7550 LUCERNE DR SUITE 405
CLEVELAND OH
44130-6588
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-2003
  • Fax: 419-479-6977
Mailing address:
  • Phone: 440-234-8833
  • Fax: 440-234-3313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704204465
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.14616-NP
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCTP.14616
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704204465
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.260869-1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: