Provider Demographics
NPI:1639132756
Name:KEENAN, COLLEEN KATHERINE (PHD, FNP, WHNP)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:KATHERINE
Last Name:KEENAN
Suffix:
Gender:F
Credentials:PHD, FNP, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 IVY ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3213
Mailing Address - Country:US
Mailing Address - Phone:310-836-5094
Mailing Address - Fax:
Practice Address - Street 1:UCLA SCHOOL OF NURSING
Practice Address - Street 2:700 TIVERTON AVENUE, BOX 956919
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-6919
Practice Address - Country:US
Practice Address - Phone:310-206-5878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNP4860AMedicare UPIN