=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336864065
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. JAMES CRAIG KEENAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2022
-----------------------------------------------------
Last Update Date | 11/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 559 W GERMANTOWN PIKE
-----------------------------------------------------
City | EAST NORRITON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19403-4250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-622-1248
-----------------------------------------------------
Fax | 484-622-1269
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 E OLNEY AVE STE 400
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19120-2470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-456-1825
-----------------------------------------------------
Fax | 215-456-5926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN610295
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | RN610295
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------