Provider Demographics
NPI:1821098989
Name:KEEFE, SUE (APRN)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:KEEFE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 2109A
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-714-6581
Mailing Address - Fax:860-714-8311
Practice Address - Street 1:114 WOODLAND ST
Practice Address - Street 2:DEPT OF GERIATRICS
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1208
Practice Address - Country:US
Practice Address - Phone:860-714-4749
Practice Address - Fax:860-714-8439
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2009-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT001744363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004222965Medicaid
CTS53942Medicare UPIN
CT004222965Medicaid