Provider Demographics
NPI:1205115383
Name:KEENEY, RENEE LYNN (CNM)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:LYNN
Last Name:KEENEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61102-2112
Mailing Address - Country:US
Mailing Address - Phone:815-490-1600
Mailing Address - Fax:815-490-1485
Practice Address - Street 1:1200 W. STATE STREET
Practice Address - Street 2:CRUSADER COMMUNITY HEALTH
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61102
Practice Address - Country:US
Practice Address - Phone:815-490-1600
Practice Address - Fax:815-490-1485
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife