Individual
SUSAN KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN,
Contact information
Practice address
130 LINCOLN PLACE CT, BELLEVILLE, IL 62221-5884
(618) 257-2029
Mailing address
4500 MEMORIAL DRIVE CREDENTIALING DEPARTMENT, MEMORIAL HOSPITAL MEDICAL AFFAIRS, BELLEVILLE, IL 62226
(618) 257-4644
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209001731
IL
Other
Enumeration date
01/28/2006
Last updated
10/22/2015
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