Provider Demographics
NPI:1043341019
Name:O'KEEFE, MARY ELLEN (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MCKENZIE AVE
Mailing Address - Street 2:#25
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7003
Mailing Address - Country:US
Mailing Address - Phone:360-255-2111
Mailing Address - Fax:360-306-3945
Practice Address - Street 1:1000 MCKENZIE AVE
Practice Address - Street 2:#25
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7003
Practice Address - Country:US
Practice Address - Phone:360-255-2111
Practice Address - Fax:360-306-3945
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003009163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG115000224Medicare ID - Type Unspecified
R31850Medicare UPIN