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NPI Code Detail

MEDICARE: MRS. MARY MARGARET KEOHANE APRN, BC, CNN

MEDICARE:  MRS. MARY MARGARET KEOHANE  APRN, BC, CNN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner155670MA

General Provider Information

NPI Number : 1376509786
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY MARGARET KEOHANE APRN, BC, CNN
Provider Business Mailing Address
First Line : 184 CEDAR ST
Second Line :
City : DEDHAM
State : MA
Zip : 02026-3338
Country : US
Telephone Number : 781-329-9710
Fax Number :
Provider Business Practice Location Address
First Line : 170 MORTON ST
Second Line :
City : JAMAICA PLAIN
State : MA
Zip : 02130-3735
Country : US
Telephone Number : 617-971-3412
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. MARY MARGARET KEOHANE APRN, BC, CNN” Practice Location

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