Provider Demographics
NPI:1497518211
Name:FRUIN, KEELY
Entity Type:Individual
Prefix:
First Name:KEELY
Middle Name:
Last Name:FRUIN
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 1:92 W CHESTNUT AVE # 1
Mailing Address - Street 2:
Mailing Address - City:MERCHANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-2366
Mailing Address - Country:US
Mailing Address - Phone:856-313-6195
Mailing Address - Fax:
Practice Address - Street 1:92 W CHESTNUT AVE # 1
Practice Address - Street 2:
Practice Address - City:MERCHANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08109-2366
Practice Address - Country:US
Practice Address - Phone:856-313-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula