Provider Demographics
NPI:1598068462
Name:KEETON, EMMA LORRAINE (ICCE, CD)
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:LORRAINE
Last Name:KEETON
Suffix:
Gender:F
Credentials:ICCE, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12648 WIMBLEY LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5076
Mailing Address - Country:US
Mailing Address - Phone:703-580-1052
Mailing Address - Fax:
Practice Address - Street 1:12648 WIMBLEY LN
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5076
Practice Address - Country:US
Practice Address - Phone:703-580-1052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula