Healthcare Provider Details

I. General information

NPI: 1184483950
Provider Name (Legal Business Name): ALLISON COURTNEY KEERAN CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 IRELAND GROVE ROAD
BLOOMINGTON IL
61704
US

IV. Provider business mailing address

108 GREGORY LANE
LEXINGTON IL
61753
US

V. Phone/Fax

Practice location:
  • Phone: 309-664-0101
  • Fax:
Mailing address:
  • Phone: 309-846-9341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: