Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 177120 | MA |
N | 363LA2200X | Nurse Practitioner - Adult Health | R048157 | ME |
NPI | 1023129723 |
---|---|
Provider Name | Ms. Patricia Ann Keohan |
First Address | Augusta, ME 04330-1240 |
Second Address | Augusta, ME 04330-8097 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 06/12/2013 |