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General NPI Number Information
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NPI Number | 1689503864
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Entity Type | Organization
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Legal Business Name | KEIZER DIABETES & METABOLISM CLINIC LLC
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Dates
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Enumeration Date | 05/14/2026
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Last Update Date | 05/14/2026
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Provider Practice Location Address
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Address Line | 4829 RIVER RD N
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City | KEIZER
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State | OR
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Zip | 97303-4537
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Country | US
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Telephone | 801-648-3824
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Fax |
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Provider Business Mailing Address
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Address Line | 4829 RIVER RD N
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City | KEIZER
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State | OR
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Zip | 97303-4537
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Country | US
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Telephone | 801-648-3824
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SANDRA DEE BUNN
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Credential | APRN CNS-PP
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Telephone | 801-648-3824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number |
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License Number State |
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