Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2007-01217 | NC |
N | 208600000X | Surgeon | 2007-01217 | NC |
Y | 2086S0120X | Pediatric Surgery | A117557 | CA |
NPI | 1376744599 |
---|---|
Provider Name | Jennifer E Keller |
First Address | Sacramento, CA 95865-5228 |
Second Address | Sacramento, CA 95819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 23/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5907236 | (05) | NC |
N01218 | (05) | SC |