Provider Demographics
NPI:1780567503
Name:KELLER, PAULA SUE (RN)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:SUE
Last Name:KELLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 37TH AVE E APT 201
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-4185
Mailing Address - Country:US
Mailing Address - Phone:715-558-5478
Mailing Address - Fax:
Practice Address - Street 1:2701 W SUPERIOR ST STE 101
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-1857
Practice Address - Country:US
Practice Address - Phone:218-733-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2464655163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health