Provider Demographics
NPI:1023088150
Name:KEENER, MARTHA JANE (CRNP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:JANE
Last Name:KEENER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BOXTHORN RD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1716
Mailing Address - Country:US
Mailing Address - Phone:410-569-8075
Mailing Address - Fax:
Practice Address - Street 1:1221 E CHURCHVILLE RD
Practice Address - Street 2:CVS/MINUTECLINIC
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015
Practice Address - Country:US
Practice Address - Phone:410-828-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR162682163WP2201X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD082NN398Medicare UPIN
DC018891M72Medicare UPIN