Provider Demographics
NPI:1508248121
Name:KEANE, BONNIE (APRN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:KEANE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:ATTN: CLINIC CREDENTIALING
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:606 24TH AVE S STE 602
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1438
Practice Address - Country:US
Practice Address - Phone:612-273-6099
Practice Address - Fax:612-273-6461
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111811363LF0000X
MNCNP5178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily