Individual
MARILOU KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNS
Contact information
Practice address
301 N SAN JACINTO ST, HEMET, CA 92543-3119
(951) 766-6460
(951) 766-6459
Mailing address
37197 BUNCHBERRY LN, MURRIETA, CA 92562-3259
(951) 766-6460
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
CNS2201
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D1062719
CLIA NUMBER
CA
01
—
1639109457
NPI
CA
Enumeration date
08/31/2006
Last updated
11/10/2008
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