Provider Demographics
NPI:1235113127
Name:KEENAN, GAIL MARY (NP)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:MARY
Last Name:KEENAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 NASHUA RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1406
Mailing Address - Country:US
Mailing Address - Phone:603-434-9583
Mailing Address - Fax:
Practice Address - Street 1:421 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5803
Practice Address - Country:US
Practice Address - Phone:978-725-4822
Practice Address - Fax:978-725-5277
Is Sole Proprietor?:No
Enumeration Date:2005-12-04
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106420163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP3955OtherBCBSMA
MANP3955OtherBCBSMA
P71260Medicare UPIN