Healthcare Provider Details

I. General information

NPI: 1407529001
Provider Name (Legal Business Name): HILLARY MARIE KEELER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5045 W GRANDE MARKET DR
APPLETON WI
54913-8517
US

IV. Provider business mailing address

5045 W GRANDE MARKET DR
APPLETON WI
54913-8517
US

V. Phone/Fax

Practice location:
  • Phone: 920-886-9380
  • Fax:
Mailing address:
  • Phone: 920-886-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1112333
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: