Provider Demographics
NPI:1275129967
Name:KEENER, LEE ANTOINETTE JANE (FNP-BC, CRNP)
Entity Type:Individual
Prefix:
First Name:LEE ANTOINETTE
Middle Name:JANE
Last Name:KEENER
Suffix:
Gender:F
Credentials:FNP-BC, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTER DRIVE 3-2740
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:240-858-9033
Mailing Address - Fax:301-480-5495
Practice Address - Street 1:10 CENTER DRIVE 3-2740
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:240-858-9033
Practice Address - Fax:301-480-5495
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC003456363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily