Provider Demographics
NPI:1841748563
Name:KELLER, ARIANNE
Entity Type:Individual
Prefix:
First Name:ARIANNE
Middle Name:
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 1:109 N MAIN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7200
Mailing Address - Country:US
Mailing Address - Phone:503-502-4190
Mailing Address - Fax:
Practice Address - Street 1:109 N MAIN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7200
Practice Address - Country:US
Practice Address - Phone:503-502-4190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist