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Individual

LISA KAY KEOWN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
550 UNIVERSITY BLVD, INDIANAPOLIS, IN 46202-5149
(317) 577-4200
(317) 577-9503
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
209011058
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
28097300A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000001100047
ANTHEM PROVIDER NUMBER
IN
01
000001664800
ANTHEM PTAN
IN
01
1102387917
ANTHEM PTAN
IN
05
300005321
IN
01
Q00372317
RAILROAD PTAN
IN
Enumeration date
12/03/2013
Last updated
12/23/2024
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