Provider Demographics
NPI:1710093471
Name:KEITHLEY, SUSAN BARBARA (CNM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BARBARA
Last Name:KEITHLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15145 AKRON ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-5609
Mailing Address - Country:US
Mailing Address - Phone:720-685-0818
Mailing Address - Fax:
Practice Address - Street 1:1850 E EGBERT ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2404
Practice Address - Country:US
Practice Address - Phone:303-637-1036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN-94792367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife