MEDICARE: BRENTON KEELE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1194335687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENTON KEELE

Provider Business Mailing Address
First Line	:	97 BRIDGE ST APT 6
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03101-1651
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	97 BRIDGE ST APT 6
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03101-1651
Country	:	US
Telephone Number	:	509-280-7350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2020
Last Update Date	:	08/09/2020

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Directions to “ BRENTON KEELE ” Practice Location

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