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General NPI Number Information
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NPI Number | 1861172892
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Entity Type | Individual
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Provider Name | MICHELE JANE KEITH APN-CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 530 NE GLEN OAK AVE
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City | PEORIA
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State | IL
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Zip | 61637-0001
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Country | US
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Telephone | 309-655-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 400 N LA SALLE DR APT 1004
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City | CHICAGO
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State | IL
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Zip | 60654-2650
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Country | US
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Telephone | 214-417-2691
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209030101
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 351572
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License Number State | NC
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