Provider Demographics
NPI:1679166185
Name:KELLER, ELENA R
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:R
Last Name:KELLER
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 1:1715 CALGARY LOOP
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0990
Mailing Address - Country:US
Mailing Address - Phone:701-527-1682
Mailing Address - Fax:
Practice Address - Street 1:1726 N 15TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-2023
Practice Address - Country:US
Practice Address - Phone:701-527-1682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider