Provider Demographics
NPI:1821256322
Name:KELLER, BOYONNEH BROOKS (LPN)
Entity Type:Individual
Prefix:MISS
First Name:BOYONNEH
Middle Name:BROOKS
Last Name:KELLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 NEW WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-3740
Mailing Address - Country:US
Mailing Address - Phone:609-396-7113
Mailing Address - Fax:
Practice Address - Street 1:624 NEW WILLOW ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-3740
Practice Address - Country:US
Practice Address - Phone:609-396-7113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP06035500251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care