Provider Demographics
NPI:1649566530
Name:KEOGH, FRANCINE GNOFFO
Entity Type:Individual
Prefix:
First Name:FRANCINE
Middle Name:GNOFFO
Last Name:KEOGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FRANCINE
Other - Middle Name:
Other - Last Name:GNOFFO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:277 BIXLEY HEATH
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3161
Mailing Address - Country:US
Mailing Address - Phone:516-860-8017
Mailing Address - Fax:
Practice Address - Street 1:277 BIXLEY HEATH
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3161
Practice Address - Country:US
Practice Address - Phone:516-860-8017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339392163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse