Healthcare Provider Details

I. General information

NPI: 1215841499
Provider Name (Legal Business Name): STEPHANIE KEENAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 PLAZA DR STE 200
ROCKLIN CA
95765-4413
US

IV. Provider business mailing address

2204 PLAZA DR STE 200
ROCKLIN CA
95765-4413
US

V. Phone/Fax

Practice location:
  • Phone: 916-622-7864
  • Fax:
Mailing address:
  • Phone: 916-622-7864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberCA513849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: