Individual
LISA MICHELLE KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2014 WASHINGTON ST, NEWTON, MA 02462-1607
(617) 219-1230
(617) 726-0453
Mailing address
801 ALBANY ST, FL G, BOSTON, MA 02119
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN258803
MA
363LA2100X
Acute Care Nurse Practitioner
RN258803
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110087835A
—
MA
Enumeration date
01/03/2007
Last updated
05/27/2022
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