Provider Demographics
NPI:1881160224
Name:ALDER, KEELIA WILLISON (CERTIFIED DOULA)
Entity type:Individual
Prefix:
First Name:KEELIA
Middle Name:WILLISON
Last Name:ALDER
Suffix:
Gender:F
Credentials:CERTIFIED DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4006 WOODSIDE CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3416
Mailing Address - Country:US
Mailing Address - Phone:978-413-8055
Mailing Address - Fax:
Practice Address - Street 1:4006 WOODSIDE CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3416
Practice Address - Country:US
Practice Address - Phone:978-413-8055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula