Provider Demographics
NPI:1063650182
Name:KEAVENY, MARY ELIZABETH (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:KEAVENY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:68 WESTOVER ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1342
Mailing Address - Country:US
Mailing Address - Phone:617-323-8497
Mailing Address - Fax:617-421-2706
Practice Address - Street 1:68 WESTOVER ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1342
Practice Address - Country:US
Practice Address - Phone:617-323-8497
Practice Address - Fax:617-421-2706
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA117221363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care