Provider Demographics
NPI:1518399484
Name:KEILEN, STEPHANIE M (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:KEILEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 LANSING ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-2400
Mailing Address - Country:US
Mailing Address - Phone:517-543-5110
Mailing Address - Fax:517-543-9776
Practice Address - Street 1:111 LANSING ST
Practice Address - Street 2:SUITE 230
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-2400
Practice Address - Country:US
Practice Address - Phone:517-543-5110
Practice Address - Fax:517-543-9776
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2020-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704260187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily