Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 605933 | WI |
N | 363LG0600X | Nurse Practitioner - Gerontology | 605933 | WI |
NPI | 1073917738 |
---|---|
Provider Name | Meghan Keyes-Lee |
First Address | Appleton, WI 54913-8442 |
Second Address | Menasha, WI 54952-1110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2014 |
Last Update Date | 09/10/2014 |