Provider Demographics
NPI:1104586478
Name:KEENE, LAREN C (RN)
Entity type:Individual
Prefix:MS
First Name:LAREN
Middle Name:C
Last Name:KEENE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 LAUREN PINES DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-7771
Mailing Address - Country:US
Mailing Address - Phone:704-460-1733
Mailing Address - Fax:
Practice Address - Street 1:248 LAUREN PINES DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-7771
Practice Address - Country:US
Practice Address - Phone:704-460-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC175105163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC102674OtherEMPLOYER REQUEST