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General NPI Number Information
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NPI Number | 1356100721
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Entity Type | Individual
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Provider Name | KEELY BROOKE RATAJCZYK FNP-BC, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/18/2024
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 12300 LAS VEGAS BLVD S
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City | HENDERSON
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State | NV
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Zip | 89044-9506
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Country | US
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Telephone | 702-837-1265
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Fax |
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Provider Business Mailing Address
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Address Line | 404 CAMINO DEL RIO S STE 102
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City | SAN DIEGO
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State | CA
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Zip | 92108-3586
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 876653
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License Number State | NV
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