Provider Demographics
NPI:1912308404
Name:KEENE, NASH WILLIAM (STUDENT)
Entity Type:Individual
Prefix:
First Name:NASH
Middle Name:WILLIAM
Last Name:KEENE
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 LIBERTY ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-8380
Mailing Address - Country:US
Mailing Address - Phone:503-371-1010
Mailing Address - Fax:
Practice Address - Street 1:2480 LIBERTY ST NE
Practice Address - Street 2:SUITE 180
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-8380
Practice Address - Country:US
Practice Address - Phone:503-371-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA174358363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical