Provider Demographics
NPI:1295700961
Name:KEENAN, MAUREEN G (NP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:G
Last Name:KEENAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:G
Other - Last Name:MAYFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2632
Mailing Address - Country:US
Mailing Address - Phone:610-292-6160
Mailing Address - Fax:610-292-6046
Practice Address - Street 1:800 RIVER RD
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2632
Practice Address - Country:US
Practice Address - Phone:610-292-6160
Practice Address - Fax:610-292-6046
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN324390OL163W00000X
PAVP006406B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
P51651Medicare UPIN
PA055285Medicare ID - Type Unspecified