Doctor Name: | DR. MARY ELIZABETH KEAVENY |
NPI Number: | 1063650182 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NURSE PRACTITIONER |
License Number: | 117221 |
Business Practice Address: | 68 Westover St West Roxbury, MA - 021321342 |
Business Phone Number: | 6173238497 |
Business Fax Number: | 6174212706 |
Mailing Address: | 68 Westover St, WEST ROXBURY |
State: | MA |
Postal Code: | 021321342 |
Phone Number: | 6173238497 |
Fax Number: | 6174212706 |
NPI Enumeration Date: | 01/27/2009 |
NPI Last Update Date: | 01/27/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2100X |
License Number: | 117221 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Acute Care |
Taxonomy Definition: |