Provider Demographics
NPI:1003287368
Name:KEIL, LAURA (CD, CPPD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KEIL
Suffix:
Gender:F
Credentials:CD, CPPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 CRESPI DR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3516
Mailing Address - Country:US
Mailing Address - Phone:650-796-9562
Mailing Address - Fax:
Practice Address - Street 1:1123 CRESPI DR
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-3516
Practice Address - Country:US
Practice Address - Phone:650-796-9562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4995374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula