Provider Demographics
NPI:1427144237
Name:KEENAN, SUZANNE HEIDI (APRN)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:HEIDI
Last Name:KEENAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 DE ANZA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3913
Mailing Address - Country:US
Mailing Address - Phone:650-341-9131
Mailing Address - Fax:650-341-9135
Practice Address - Street 1:218 DE ANZA BLVD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3913
Practice Address - Country:US
Practice Address - Phone:650-341-9131
Practice Address - Fax:650-341-9135
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT070145163W00000X
CA390724163W00000X
CT003457363LA2200X
CANP17799363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ78927Medicare UPIN