Provider Demographics
NPI:1194366062
Name:KELLER, NAN GULNAC
Entity Type:Individual
Prefix:
First Name:NAN
Middle Name:GULNAC
Last Name:KELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 MAIDEN LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-1246
Mailing Address - Country:US
Mailing Address - Phone:585-966-4705
Mailing Address - Fax:585-966-4778
Practice Address - Street 1:2089 MAIDEN LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-1246
Practice Address - Country:US
Practice Address - Phone:585-966-4705
Practice Address - Fax:585-966-4778
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297972-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool