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General NPI Number Information
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NPI Number | 1942339007
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Entity Type | Individual
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Provider Name | COLLEEN KELLER FNP, RN
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 500 N 3RD ST
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City | PHOENIX
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State | AZ
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Zip | 85004-2129
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Country | US
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Telephone | 602-496-0782
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Fax |
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Provider Business Mailing Address
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Address Line | 1402 E HUBBELL ST
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City | PHOENIX
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State | AZ
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Zip | 85006-1751
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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 | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | RN032560
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | FNP 369
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License Number State | AZ
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