Provider Demographics
NPI:1184011199
Name:KEEFE, LEIGHANA (RN)
Entity Type:Individual
Prefix:
First Name:LEIGHANA
Middle Name:
Last Name:KEEFE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1824
Mailing Address - Country:US
Mailing Address - Phone:631-560-6029
Mailing Address - Fax:
Practice Address - Street 1:45 BLYDENBURGH RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-4301
Practice Address - Country:US
Practice Address - Phone:631-737-1788
Practice Address - Fax:631-737-1441
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6911041-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse