Provider Demographics
NPI:1104185503
Name:O'KEEFE, BREANNA LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:BREANNA
Middle Name:LYNN
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 CENTENNIAL WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8246
Mailing Address - Country:US
Mailing Address - Phone:517-705-3910
Mailing Address - Fax:517-705-3911
Practice Address - Street 1:912 CENTENNIAL WAY STE 300
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8246
Practice Address - Country:US
Practice Address - Phone:517-705-3910
Practice Address - Fax:517-705-3911
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine