Provider Demographics
NPI:1124017553
Name:KEANE, TERESA CATHERINE (RN, MSN, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:CATHERINE
Last Name:KEANE
Suffix:
Gender:F
Credentials:RN, MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 N INTERSTATE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1196
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3325 N INTERSATE AVE
Practice Address - Street 2:KAISER PERMANENTE
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1099
Practice Address - Country:US
Practice Address - Phone:503-331-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR090006025N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR076666OtherPMHNP
OR076666OtherPMHNP
ORS42053Medicare UPIN