Provider Demographics
NPI:1003816117
Name:MCKEEFF, DIANE (NP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MCKEEFF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5 CASWELL ST
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3326
Mailing Address - Country:US
Mailing Address - Phone:401-789-7137
Mailing Address - Fax:401-685-0420
Practice Address - Street 1:55 CHERRY LN
Practice Address - Street 2:SUITE 1B
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3617
Practice Address - Country:US
Practice Address - Phone:401-789-7137
Practice Address - Fax:401-685-0420
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIAPRN00615363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU100327058Medicare PIN
P05930Medicare UPIN