Provider Demographics
NPI:1295813285
Name:KEEGAN, LAURA TERESA (RN FNP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:TERESA
Last Name:KEEGAN
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SUNNY LANE
Mailing Address - Street 2:
Mailing Address - City:STORMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12582
Mailing Address - Country:US
Mailing Address - Phone:914-449-2027
Mailing Address - Fax:
Practice Address - Street 1:17 SUNNY LANE
Practice Address - Street 2:
Practice Address - City:STORMVILLE
Practice Address - State:NY
Practice Address - Zip Code:12582
Practice Address - Country:US
Practice Address - Phone:914-449-2027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390787163W00000X
NYF330100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily