Provider Demographics
NPI:1366555138
Name:KEANE, JANICE ELIZABETH (MNS NP C)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:ELIZABETH
Last Name:KEANE
Suffix:
Gender:F
Credentials:MNS NP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 SATURN DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-3017
Mailing Address - Country:US
Mailing Address - Phone:302-239-7732
Mailing Address - Fax:
Practice Address - Street 1:313 WEST MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-3217
Practice Address - Country:US
Practice Address - Phone:302-731-4620
Practice Address - Fax:302-731-8791
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000232363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE005800N30Medicare ID - Type Unspecified
S97927Medicare UPIN