Doctor Name: | RANITA KELLER |
NPI Number: | 1083096895 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 209.012861 |
Business Practice Address: | 1285 Franciscan Dr Litchfield, IL - 620561778 |
Business Phone Number: | 2173246127 |
Business Fax Number: | 2173245959 |
Mailing Address: | 1285 Franciscan Dr, LITCHFIELD |
State: | IL |
Postal Code: | 620561778 |
Phone Number: | 2173246127 |
Fax Number: | 2173245959 |
NPI Enumeration Date: | 06/29/2015 |
NPI Last Update Date: | 06/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209.012861 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |