Provider Demographics
NPI:1215365606
Name:KEITA, MARIA TARLUE (NP)
Entity Type:Individual
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First Name:MARIA
Middle Name:TARLUE
Last Name:KEITA
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Gender:F
Credentials:NP
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Mailing Address - Street 1:3433 BROADWAY ST NE
Mailing Address - Street 2:STE 300
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1761
Mailing Address - Country:US
Mailing Address - Phone:763-587-7737
Mailing Address - Fax:763-587-7069
Practice Address - Street 1:1055 WESTGATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1065
Practice Address - Country:US
Practice Address - Phone:612-262-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2021-03-11
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Provider Licenses
StateLicense IDTaxonomies
MN161983-0363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology