Healthcare Provider Details

I. General information

NPI: 1093485419
Provider Name (Legal Business Name): CHRISTIANA KEEBLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BROADWAY SUITE 2018
SEATTLE WA
98122
US

IV. Provider business mailing address

325 9TH AVE # MS 359846
SEATTLE WA
98104-2420
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-6545
  • Fax:
Mailing address:
  • Phone: 206-744-6545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN602199985
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: