Provider Demographics
NPI:1275189334
Name:KEENAN, OLIVIA RAFFAELLA-ANNA (PA-C)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:RAFFAELLA-ANNA
Last Name:KEENAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21401 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1665
Mailing Address - Country:US
Mailing Address - Phone:734-675-0835
Mailing Address - Fax:734-675-0873
Practice Address - Street 1:21401 ALLEN RD
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-1665
Practice Address - Country:US
Practice Address - Phone:734-675-0835
Practice Address - Fax:734-675-0873
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009409207N00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207N00000XAllopathic & Osteopathic PhysiciansDermatology