Provider Demographics
NPI:1477635795
Name:KELLER, MARCIA (MS, RN, CS, ANP-BC)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:MS, RN, CS, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CANAL VIEW BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2808
Mailing Address - Country:US
Mailing Address - Phone:585-338-2700
Mailing Address - Fax:585-242-9663
Practice Address - Street 1:140 CANAL VIEW BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2808
Practice Address - Country:US
Practice Address - Phone:585-338-2700
Practice Address - Fax:585-242-9663
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300644363L00000X
NYF300644363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PO19300644OtherBLUE CHOICE
000918192001OtherHEALTHNOW
NP0356OtherPREFERRED CARE
918192001OtherCOMMUNITY BLUE
918192001OtherCOMMUNITY BLUE
918192001OtherCOMMUNITY BLUE