Provider Demographics
NPI:1922086180
Name:KELLER, JANE M (ARNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:KELLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3421 W 9TH ST STE G4500
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5401
Mailing Address - Country:US
Mailing Address - Phone:319-272-8200
Mailing Address - Fax:319-272-0400
Practice Address - Street 1:3421 W 9TH ST
Practice Address - Street 2:SUITE G4500
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5401
Practice Address - Country:US
Practice Address - Phone:319-233-8865
Practice Address - Fax:319-272-0400
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA077228363LX0001X
IAA077228363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology