Provider Demographics
NPI:1780932772
Name:KEISTER, TRICIA LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:LYNN
Last Name:KEISTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TRESSY
Other - Middle Name:LYNN
Other - Last Name:KEISTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:N6028 COUNTY ROAD D
Mailing Address - Street 2:
Mailing Address - City:KEWAUNEE
Mailing Address - State:WI
Mailing Address - Zip Code:54216-9736
Mailing Address - Country:US
Mailing Address - Phone:920-304-0293
Mailing Address - Fax:
Practice Address - Street 1:N6028 COUNTY ROAD D
Practice Address - Street 2:
Practice Address - City:KEWAUNEE
Practice Address - State:WI
Practice Address - Zip Code:54216
Practice Address - Country:US
Practice Address - Phone:920-304-0293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI176805030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse