Healthcare Provider Details

I. General information

NPI: 1093869760
Provider Name (Legal Business Name): JANE K KEANE APN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 GROSS POINT RD
SKOKIE IL
60076-1214
US

IV. Provider business mailing address

6140 N KILPATRICK AVE
CHICAGO IL
60646-5043
US

V. Phone/Fax

Practice location:
  • Phone: 847-933-6207
  • Fax: 847-933-3533
Mailing address:
  • Phone: 773-282-4587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number209004034
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: