Provider Demographics
NPI:1174261481
Name:KEENER, ERIEL MARIE
Entity type:Individual
Prefix:
First Name:ERIEL
Middle Name:MARIE
Last Name:KEENER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4476 S 120 W APT 203
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3293
Mailing Address - Country:US
Mailing Address - Phone:385-770-8533
Mailing Address - Fax:
Practice Address - Street 1:4476 S 120 W APT 203
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-3293
Practice Address - Country:US
Practice Address - Phone:385-770-8533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator