Provider Demographics
NPI:1821327768
Name:KEELY, SHANNON DEE (RN IBCLC RLC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:DEE
Last Name:KEELY
Suffix:
Gender:F
Credentials:RN IBCLC RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 SHIRE LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-1021
Mailing Address - Country:US
Mailing Address - Phone:910-508-2147
Mailing Address - Fax:
Practice Address - Street 1:3505 CONVERSE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6131
Practice Address - Country:US
Practice Address - Phone:910-392-5634
Practice Address - Fax:910-392-5654
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC215454163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant