Provider Demographics
NPI:1558838474
Name:WARREN, KEELEY M
Entity Type:Individual
Prefix:
First Name:KEELEY
Middle Name:M
Last Name:WARREN
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 1:2190 W 10TH AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-6707
Mailing Address - Country:US
Mailing Address - Phone:402-598-0496
Mailing Address - Fax:
Practice Address - Street 1:2190 W 10TH AVE APT 203
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-6707
Practice Address - Country:US
Practice Address - Phone:402-598-0496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator