Individual
LYNN SECUNDE KELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1477 PATTON DR, BOULDER, CO 80303-1258
(720) 989-8181
Mailing address
1477 PATTON DR, BOULDER, CO 80303-1258
(720) 989-8181
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
130914
CO
163WM1400X
Nurse Massage Therapist (NMT)
130914
CO
363LA2200X
Adult Health Nurse Practitioner
F302220-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F302220-1
NY LICENSE
—
01
—
RN-130914
RN LICENSE
CO
Enumeration date
06/16/2018
Last updated
06/16/2018
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