Provider Demographics
NPI:1790897809
Name:KEITZ, JANICE EVELYN (NP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:EVELYN
Last Name:KEITZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GREENWAY PLZ
Mailing Address - Street 2:SUITE 2950
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0905
Mailing Address - Country:US
Mailing Address - Phone:866-607-7334
Mailing Address - Fax:713-358-4801
Practice Address - Street 1:12000 IRON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1459
Practice Address - Country:US
Practice Address - Phone:804-748-7117
Practice Address - Fax:804-748-6166
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001051220163W00000X
VA0024051220363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP55103Medicare UPIN
VA006186M91Medicare ID - Type Unspecified
VA00X49N07Medicare PIN