Healthcare Provider Details

I. General information

NPI: 1861622912
Provider Name (Legal Business Name): KEEGAN WOCN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7060 SPRINGHILL CIR
EDEN PRAIRIE MN
55346-2615
US

IV. Provider business mailing address

7060 SPRINGHILL CIR
EDEN PRAIRIE MN
55346-2615
US

V. Phone/Fax

Practice location:
  • Phone: 952-937-9889
  • Fax: 952-937-9889
Mailing address:
  • Phone: 952-937-9889
  • Fax: 952-937-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License Number199925527
License Number StateMN

VIII. Authorized Official

Name: MS. IRENE PATRICIA KEEGAN
Title or Position: PRESIDENT
Credential: RN, WOCN
Phone: 952-937-9889