Provider Demographics
NPI:1629486139
Name:KEEGAN, LAURIE (CNP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:KEEGAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:DIRCKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:27 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1413
Mailing Address - Country:US
Mailing Address - Phone:978-505-2854
Mailing Address - Fax:
Practice Address - Street 1:120 WATER ST
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-2648
Practice Address - Country:US
Practice Address - Phone:978-558-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202776163WC1500X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health