Provider Demographics
NPI:1003176645
Name:KEELEY, MARY (CPM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KEELEY
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:ZAINA
Other - Middle Name:
Other - Last Name:KEELEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3506 COUNTRYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1520
Mailing Address - Country:US
Mailing Address - Phone:304-258-9504
Mailing Address - Fax:717-790-2747
Practice Address - Street 1:3506 COUNTRYSIDE LN
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1520
Practice Address - Country:US
Practice Address - Phone:304-258-9504
Practice Address - Fax:717-790-2747
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0012379281Medicaid