Healthcare Provider Details

I. General information

NPI: 1649353178
Provider Name (Legal Business Name): SUSAN KEILMAN A.R.N.P., C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 BOGACHIEL WAY
FORKS WA
98331
US

IV. Provider business mailing address

590 BOGACHIEL WAY
FORKS WA
98331
US

V. Phone/Fax

Practice location:
  • Phone: 360-374-6271
  • Fax: 360-374-9781
Mailing address:
  • Phone: 360-374-6271
  • Fax: 360-374-9781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAP30000345
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30000345
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: