Individual
TAWNYA D. O'KEEFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
420 E INDIANA AVE, COEUR D ALENE, ID 83814-2989
(208) 797-3597
Mailing address
204 N 4TH ST, COEUR D ALENE, ID 83814-2810
(208) 797-3597
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP421-A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13429732
MEDICARE PTAN
—
01
—
1370136
MEDICARE GROUP PTAN
—
05
—
805757300
—
ID
05
—
8080036
—
ID
Enumeration date
09/15/2006
Last updated
10/19/2022
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