Provider Demographics
NPI:1205559234
Name:THOMASHOW-KEEGAN, LISA M
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:THOMASHOW-KEEGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 FLETCHER FARM RD
Mailing Address - Street 2:
Mailing Address - City:VERMONTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12989-3522
Mailing Address - Country:US
Mailing Address - Phone:518-637-5074
Mailing Address - Fax:
Practice Address - Street 1:159 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-2385
Practice Address - Country:US
Practice Address - Phone:518-637-5074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY554309163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse