Provider Demographics
NPI:1154066223
Name:KEEFE, LISA M (RN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:KEEFE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:YOUNIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 PARKSIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102
Mailing Address - Country:US
Mailing Address - Phone:603-624-6356
Mailing Address - Fax:603-624-6355
Practice Address - Street 1:PARKSIDE MIDDLE SCHOOL
Practice Address - Street 2:75 PARKSIDE AVENUE
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102
Practice Address - Country:US
Practice Address - Phone:603-624-6356
Practice Address - Fax:603-624-6355
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHRN051488-21251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)