Provider Demographics
NPI:1922784677
Name:KELLER, CLARE JL
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:JL
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 1:1385 W LOCHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-2480
Mailing Address - Country:US
Mailing Address - Phone:402-705-6512
Mailing Address - Fax:
Practice Address - Street 1:1385 W LOCHLAND RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2480
Practice Address - Country:US
Practice Address - Phone:402-705-6512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program