Healthcare Provider Details

I. General information

NPI: 1740214832
Provider Name (Legal Business Name): ALICIA KEENAN HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA MARIE KEENAN RN, NP-C

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CENTRE ST
BOSTON MA
02131-1011
US

IV. Provider business mailing address

819 WORCESTER ST 3
SPRINGFIELD MA
01151-1056
US

V. Phone/Fax

Practice location:
  • Phone: 617-363-8293
  • Fax:
Mailing address:
  • Phone: 413-543-6820
  • Fax: 413-543-7962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number252099
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: