Healthcare Provider Details

I. General information

NPI: 1689503864
Provider Name (Legal Business Name): KEIZER DIABETES & METABOLISM CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 RIVER RD N
KEIZER OR
97303-4537
US

IV. Provider business mailing address

4829 RIVER RD N
KEIZER OR
97303-4537
US

V. Phone/Fax

Practice location:
  • Phone: 801-648-3824
  • Fax:
Mailing address:
  • Phone: 801-648-3824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: SANDRA DEE BUNN
Title or Position: OWNER
Credential: APRN CNS-PP
Phone: 801-648-3824