Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1003176645 |
---|---|
Provider Name | Mary Keeley |
First Address | Camp Hill, PA 17011-1520 |
Second Address | Camp Hill, PA 17011-1520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2012 |
Last Update Date | 23/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012379281 | (05) | VA |