Healthcare Provider Details

I. General information

NPI: 1689688996
Provider Name (Legal Business Name): EUGENIE R. KEEL RN, MSN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 ELM ST VA PRIMARY CARE CLINIC
NEW BEDFORD MA
02740-6006
US

IV. Provider business mailing address

30 EDGEWATER LN
MARION MA
02738-1204
US

V. Phone/Fax

Practice location:
  • Phone: 508-994-0217
  • Fax: 508-994-5489
Mailing address:
  • Phone: 508-748-6781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number246402
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: