Healthcare Provider Details

I. General information

NPI: 1457505141
Provider Name (Legal Business Name): REGINA MARIE KEATING FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2008
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 DERRY RD
HUDSON NH
03051-3023
US

IV. Provider business mailing address

300 DERRY RD
HUDSON NH
03051-3023
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-2273
  • Fax: 603-579-5191
Mailing address:
  • Phone: 603-577-2273
  • Fax: 603-577-5191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number029629-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: