Provider Demographics
NPI:1366471252
Name:KEEFE-TOMASELLO, JOANNE M (NP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:M
Last Name:KEEFE-TOMASELLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1818 HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2619
Mailing Address - Country:US
Mailing Address - Phone:803-758-2602
Mailing Address - Fax:803-253-8896
Practice Address - Street 1:1851 SAM RITTENBERG BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4861
Practice Address - Country:US
Practice Address - Phone:843-556-5585
Practice Address - Fax:843-556-5587
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1259363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S57515Medicare UPIN