Provider Demographics
NPI:1063286334
Name:KEYES, CAROLYN R (RN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:R
Last Name:KEYES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:R
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:450 MASTEN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1727
Mailing Address - Country:US
Mailing Address - Phone:716-816-4213
Mailing Address - Fax:716-888-7136
Practice Address - Street 1:450 MASTEN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1727
Practice Address - Country:US
Practice Address - Phone:716-816-4213
Practice Address - Fax:716-888-7136
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390905-01163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool