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NPI Code Detail

MEDICARE: THERESA DIANE KEEFER CRNA

MEDICARE:   THERESA DIANE KEEFER  CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistAPN.0100024-CRNACO

General Provider Information

NPI Number : 1477857274
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA DIANE KEEFER CRNA
Provider Business Mailing Address
First Line : 2920 N CASCADE AVE
Second Line : FL 3
City : COLORADO SPRINGS
State : CO
Zip : 80907-6262
Country : US
Telephone Number : 719-285-2861
Fax Number : 719-285-2101
Provider Business Practice Location Address
First Line : 1338 PHAY AVE
Second Line :
City : CANON CITY
State : CO
Zip : 81212-2311
Country : US
Telephone Number : 719-285-2861
Fax Number : 719-285-2101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2011
Last Update Date : 07/21/2022

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Directions to “ THERESA DIANE KEEFER CRNA” Practice Location

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