Provider Demographics
NPI:1225277791
Name:KEANEY, DIANE MOSKOWITZ (RN, MSN, ACHPN)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MOSKOWITZ
Last Name:KEANEY
Suffix:
Gender:F
Credentials:RN, MSN, ACHPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 NORTHGATE DR
Mailing Address - Street 2:STE 410
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2584
Mailing Address - Country:US
Mailing Address - Phone:415-380-0480
Mailing Address - Fax:
Practice Address - Street 1:3 HARBOR DR
Practice Address - Street 2:SUITE 115
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1454
Practice Address - Country:US
Practice Address - Phone:415-380-0480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370895163WP0000X
CA3017364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163WP0000XNursing Service ProvidersRegistered NursePain Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABQ800ZMedicare UPIN