Healthcare Provider Details

I. General information

NPI: 1669211405
Provider Name (Legal Business Name): ANN M KEENAN AGNP, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ANN DAHLKEMPER

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 HARMON LOOP RD STE 102
DEDEDO GU
96929-6544
US

IV. Provider business mailing address

809 CHALAN PASAHERU UNIT 2
TAMUNING GU
96913-4132
US

V. Phone/Fax

Practice location:
  • Phone: 671-989-6600
  • Fax: 671-989-8836
Mailing address:
  • Phone: 671-647-5355
  • Fax: 671-649-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number100208
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: