MEDICARE: JOHN J KEELEN CRNP

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	363L00000X	Nurse Practitioner	SP018108	PA

General Provider Information

NPI Number	:	1831603760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN J KEELEN CRNP

Provider Business Mailing Address
First Line	:	801 OSTRUM ST
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18015-1000
Country	:	US
Telephone Number	:	484-526-4999
Fax Number	:	484-526-6500

Provider Business Practice Location Address
First Line	:	208 LIFELINE RD STE 201
Second Line	:
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-6473
Country	:	US
Telephone Number	:	570-476-6700
Fax Number	:	570-476-0735

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

Provider Enumeration Date	:	11/30/2017
Last Update Date	:	11/30/2017

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