Provider Demographics
NPI:1306381785
Name:KEEGAN, LISA (AGPCNP-BC, WHNP-BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KEEGAN
Suffix:
Gender:F
Credentials:AGPCNP-BC, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 PROFESSORS ROW
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5816
Mailing Address - Country:US
Mailing Address - Phone:617-627-3350
Mailing Address - Fax:
Practice Address - Street 1:124 PROFESSORS ROW
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5816
Practice Address - Country:US
Practice Address - Phone:617-627-3350
Practice Address - Fax:617-627-3592
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2299338363LW0102X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health