Individual
EILEEN F KEANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
374 GRAND AVE, NEW HAVEN, CT 06513-3733
(203) 777-7411
(203) 777-8506
Mailing address
374 GRAND AVE, NEW HAVEN, CT 06513-3733
(203) 777-7411
(203) 777-8506
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
006169
CT
363LP0200X
Pediatric Nurse Practitioner
Primary
6169
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1300709
—
MA
01
—
56780
FALLON SELECT
MA
01
—
NP9903
BCBS
MA
01
—
Y10141
BCBS-GROUP
MA
Enumeration date
08/10/2006
Last updated
11/29/2018
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