Healthcare Provider Details

I. General information

NPI: 1336763499
Provider Name (Legal Business Name): JILL RENAE KEANE DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E UNIVERSITY AVE
DES MOINES IA
50316-2392
US

IV. Provider business mailing address

5405 WOODLAND AVE
WEST DES MOINES IA
50266-7259
US

V. Phone/Fax

Practice location:
  • Phone: 515-263-5612
  • Fax:
Mailing address:
  • Phone: 515-570-0312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number127773
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: