Provider Demographics
NPI:1316989387
Name:KEANE, DOROTHY M (RN NP)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:M
Last Name:KEANE
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PETER COOPER RD
Mailing Address - Street 2:APT. 11F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6735
Mailing Address - Country:US
Mailing Address - Phone:212-228-9380
Mailing Address - Fax:
Practice Address - Street 1:4 PETER COOPER RD
Practice Address - Street 2:APT. 11F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6735
Practice Address - Country:US
Practice Address - Phone:212-228-9380
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304361363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health