Provider Demographics
NPI:1982064663
Name:KEANE, DEIRDRE MARIE (NP)
Entity Type:Individual
Prefix:MISS
First Name:DEIRDRE
Middle Name:MARIE
Last Name:KEANE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2959 GRAND CONCOURSE APT 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1443
Mailing Address - Country:US
Mailing Address - Phone:917-617-6823
Mailing Address - Fax:
Practice Address - Street 1:2959 GRAND CONCOURSE APT 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1443
Practice Address - Country:US
Practice Address - Phone:917-617-6823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY649306163W00000X
NY341703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse