Provider Demographics
NPI:1750517637
Name:KEANE, HEATHER DIANE (RN,CNOR,RNFA)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:DIANE
Last Name:KEANE
Suffix:
Gender:F
Credentials:RN,CNOR,RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 E TETON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-6220
Mailing Address - Country:US
Mailing Address - Phone:307-262-2467
Mailing Address - Fax:
Practice Address - Street 1:2105 E TETON BLVD
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-6220
Practice Address - Country:US
Practice Address - Phone:307-262-2467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY16282163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant