Provider Demographics
NPI:1356922611
Name:KEEFE-GARNER, ELLEN MARIE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:KEEFE-GARNER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MISS
Other - First Name:ELLEN
Other - Middle Name:MARIE
Other - Last Name:KEEFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1610 SHADFORD RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4465
Mailing Address - Country:US
Mailing Address - Phone:734-604-8969
Mailing Address - Fax:
Practice Address - Street 1:2020 E GRAND RIVER AVE STE 104
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2478
Practice Address - Country:US
Practice Address - Phone:517-545-5944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704224601363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner