Provider Demographics
NPI:1710027420
Name:KELLER, LAURA SUZANNE (RN, NP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:SUZANNE
Last Name:KELLER
Suffix:
Gender:F
Credentials:RN, NP
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Mailing Address - Street 1:50 CLEMENT CT
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6516
Mailing Address - Country:US
Mailing Address - Phone:707-253-4385
Mailing Address - Fax:707-253-4880
Practice Address - Street 1:2344 OLD SONOMA RD
Practice Address - Street 2:BUILDING G
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-3708
Practice Address - Country:US
Practice Address - Phone:707-253-4385
Practice Address - Fax:707-253-4880
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA395683363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health