Healthcare Provider Details

I. General information

NPI: 1073430807
Provider Name (Legal Business Name): KEELEY MAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 12TH AVE
SEATTLE WA
98122-4411
US

IV. Provider business mailing address

901 12TH AVE
SEATTLE WA
98122-4411
US

V. Phone/Fax

Practice location:
  • Phone: 206-296-2000
  • Fax:
Mailing address:
  • Phone: 206-296-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61588613
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10061789
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: