Provider Demographics
NPI:1871030122
Name:KEYZER, BOBBI (RN)
Entity Type:Individual
Prefix:MRS
First Name:BOBBI
Middle Name:
Last Name:KEYZER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 129TH AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49344-9509
Mailing Address - Country:US
Mailing Address - Phone:616-437-1007
Mailing Address - Fax:
Practice Address - Street 1:972 129TH AVE
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:MI
Practice Address - Zip Code:49344-9509
Practice Address - Country:US
Practice Address - Phone:616-437-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704342237163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse