Provider Demographics
NPI:1558814103
Name:BURRER, KEELY MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:KEELY
Middle Name:MARIE
Last Name:BURRER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KEELY
Other - Middle Name:MARIE
Other - Last Name:ZEISLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1522 SHELBY GANGES RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-9390
Mailing Address - Country:US
Mailing Address - Phone:419-971-6757
Mailing Address - Fax:
Practice Address - Street 1:799 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1906
Practice Address - Country:US
Practice Address - Phone:419-756-5133
Practice Address - Fax:419-774-9707
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.361399367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered