Provider Demographics
NPI:1609046143
Name:KEANE, ERIN MULLANEY (RN, PPCNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:MULLANEY
Last Name:KEANE
Suffix:
Gender:F
Credentials:RN, PPCNP-BC
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:KATHLEEN
Other - Last Name:MULLANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PPCNP-BC
Mailing Address - Street 1:2200 WHITNEY AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3602
Mailing Address - Country:US
Mailing Address - Phone:203-287-5400
Mailing Address - Fax:203-281-3001
Practice Address - Street 1:2200 WHITNEY AVE STE 240
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3602
Practice Address - Country:US
Practice Address - Phone:203-287-5400
Practice Address - Fax:203-381-3001
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.009460363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics