Basic Information
| Provider Information | |||||||||
| NPI: | 1902262777 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEYSER | ||||||||
| FirstName: | LAINE | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7000 ATRIUM WAY | ||||||||
| Address2: | STE 6 | ||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080543917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562064500 | ||||||||
| FaxNumber: | 8562344241 | ||||||||
| Practice Location | |||||||||
| Address1: | 485 WILLIAMSTOWN RD | ||||||||
| Address2: | |||||||||
| City: | SICKLERVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080811777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563418457 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2016 | ||||||||
| LastUpdateDate: | 03/13/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | SP015794 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | 26NJ00633400 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.