Individual
CLAYTON W KEENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
530 SMITH AVE, OCONTO, WI 54153-1010
(920) 834-7600
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
6529-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100047664
—
WI
01
—
1568552958
CLINIC NPI
WI
01
—
1851477913
ST. CLARE NPI
WI
Enumeration date
08/14/2015
Last updated
08/28/2024
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