Provider Demographics
NPI:1972908358
Name:KEANE, CYNTHIA TANNER (RN)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:TANNER
Last Name:KEANE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2583
Mailing Address - Country:US
Mailing Address - Phone:707-645-7210
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL DR STE 303
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2583
Practice Address - Country:US
Practice Address - Phone:707-645-7210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 364762163W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse