Healthcare Provider Details

I. General information

NPI: 1497029144
Provider Name (Legal Business Name): MEGAN KEATING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 52ND ST.
OAKLAND CA
94609
US

IV. Provider business mailing address

1393 GUERRERO ST APT. 3
SAN FRANCISCO CA
94110-3673
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3885
  • Fax: 510-601-3957
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number20938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: