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General NPI Number Information
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NPI Number | 1447861778
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Entity Type | Individual
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Provider Name | LAUREN KEENEY
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Gender | Female
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Dates
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Enumeration Date | 08/11/2020
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 1014 BURRELL AVE
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City | LEWISTON
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State | ID
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Zip | 83501-5472
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Country | US
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Telephone | 208-743-4558
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Fax |
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Provider Business Mailing Address
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Address Line | 614 S BLAINE ST APT 5
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City | MOSCOW
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State | ID
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Zip | 83843-3794
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Country | US
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Telephone | 208-596-8284
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 086101186
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License Number State | ID
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