Healthcare Provider Details

I. General information

NPI: 1740326628
Provider Name (Legal Business Name): WILLIAM E KEPPEL RN, CNOR, CRNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 2ND ST 4TH FLOOR
ERIE PA
16507-1537
US

IV. Provider business mailing address

926 WEBER LN
ERIE PA
16509-4858
US

V. Phone/Fax

Practice location:
  • Phone: 814-453-6751
  • Fax:
Mailing address:
  • Phone: 814-864-7026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN289741L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: