Provider Demographics
NPI:1285780973
Name:KEENAN, CHRISTINE M (LDN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:KEENAN
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-2805
Mailing Address - Country:US
Mailing Address - Phone:413-562-8200
Mailing Address - Fax:
Practice Address - Street 1:41 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-2805
Practice Address - Country:US
Practice Address - Phone:413-562-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1169133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALD0070OtherBLUECROSSBLUESHIELD
MALD0070OtherBLUECROSSBLUESHIELD