Individual
THERESA M KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1260 CROSSING MEADOWS DR, ONALASKA, WI 54650-8666
(608) 775-5858
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
0192371-22
MN
363LF0000X
Family Nurse Practitioner
Primary
9675
WI
363LF0000X
Family Nurse Practitioner
A-064032
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0076372
—
IA
01
—
01-07133
MEDICA
MN
05
—
295450800
—
MN
01
—
47G21KE
BLUE CROSS BLUE SHIELD
MN
Enumeration date
06/10/2006
Last updated
12/05/2019
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