Provider Demographics
NPI:1669211405
Name:KEENAN, ANN M (AGNP, CCRN)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:KEENAN
Suffix:
Gender:F
Credentials:AGNP, CCRN
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:DAHLKEMPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:809 CHALAN PASAHERU UNIT 2
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-4132
Mailing Address - Country:US
Mailing Address - Phone:671-647-5355
Mailing Address - Fax:671-649-0404
Practice Address - Street 1:655 HARMON LOOP RD STE 102
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6544
Practice Address - Country:US
Practice Address - Phone:671-989-6600
Practice Address - Fax:671-989-8836
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU100208363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner