Provider Demographics
NPI:1295052736
Name:KEENER, DIANA (MAC LAC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:KEENER
Suffix:
Gender:F
Credentials:MAC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 YELLOWWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4622
Mailing Address - Country:US
Mailing Address - Phone:410-542-4088
Mailing Address - Fax:
Practice Address - Street 1:4801 YELLOWWOOD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4622
Practice Address - Country:US
Practice Address - Phone:410-542-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO1178171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist