MEDICARE: MS. JANICE L. KEANE A.N.P.

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	209001890	IL

General Provider Information

NPI Number	:	1871502955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANICE L. KEANE A.N.P.

Provider Business Mailing Address
First Line	:	19 RIVER OAKS DR
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-5802
Country	:	US
Telephone Number	:	708-862-1290
Fax Number	:	708-862-6447

Provider Business Practice Location Address
First Line	:	19 RIVER OAKS DR
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-5802
Country	:	US
Telephone Number	:	708-862-1290
Fax Number	:

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

Provider Enumeration Date	:	08/06/2006
Last Update Date	:	07/13/2011

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