Healthcare Provider Details

I. General information

NPI: 1235113127
Provider Name (Legal Business Name): GAIL MARY KEENAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2005
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 MERRIMACK ST
METHUEN MA
01844-5803
US

IV. Provider business mailing address

57 NASHUA RD
WINDHAM NH
03087-1406
US

V. Phone/Fax

Practice location:
  • Phone: 978-725-4822
  • Fax: 978-725-5277
Mailing address:
  • Phone: 603-434-9583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number106420
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: