Provider Demographics
NPI:1467513028
Name:EXNER, KEISCH ANN (LMP)
Entity Type:Individual
Prefix:
First Name:KEISCH
Middle Name:ANN
Last Name:EXNER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:CAREYWOOD
Mailing Address - State:ID
Mailing Address - Zip Code:83809-0036
Mailing Address - Country:US
Mailing Address - Phone:425-870-7777
Mailing Address - Fax:
Practice Address - Street 1:8475 N GOVERNMENT WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8670
Practice Address - Country:US
Practice Address - Phone:208-762-6772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA512452-06174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist