Healthcare Provider Details

I. General information

NPI: 1871422808
Provider Name (Legal Business Name): THERESA KEANE R.N., B.S.N. R.N.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4567 E 9TH AVE
DENVER CO
80220-3908
US

IV. Provider business mailing address

2525 S DAYTON WAY APT 2208
DENVER CO
80231-3918
US

V. Phone/Fax

Practice location:
  • Phone: 303-320-2550
  • Fax:
Mailing address:
  • Phone: 303-320-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number1635475
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: