Individual
KEITH A. EGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8415 STATE ROAD 205, CHURUBUSCO, IN 46723-9234
(260) 417-2775
Mailing address
8415 STATE ROAD 205, CHURUBUSCO, IN 46723-9234
(260) 417-2775
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
110355
WV
Other
Enumeration date
08/19/2021
Last updated
08/19/2021
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