Provider Demographics
NPI:1912861592
Name:LEPSCH, KEITH
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:LEPSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 TEWA LOOP
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-3210
Mailing Address - Country:US
Mailing Address - Phone:505-920-0712
Mailing Address - Fax:505-920-0712
Practice Address - Street 1:941 TEWA LOOP
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3210
Practice Address - Country:US
Practice Address - Phone:505-920-0712
Practice Address - Fax:505-920-0712
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-09
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR51653163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine