1609046143 NPI number — MS. ERIN MULLANEY KEANE RN, PPCNP-BC

Table of content: MS. ERIN MULLANEY KEANE RN, PPCNP-BC (NPI 1609046143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609046143 NPI number — MS. ERIN MULLANEY KEANE RN, PPCNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEANE
Provider First Name:
ERIN
Provider Middle Name:
MULLANEY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN, PPCNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MULLANEY
Provider Other First Name:
ERIN
Provider Other Middle Name:
KATHLEEN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, PPCNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609046143
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 WHITNEY AVE STE 240
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06518-3602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-287-5400
Provider Business Mailing Address Fax Number:
203-281-3001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 WHITNEY AVE STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06518-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-287-5400
Provider Business Practice Location Address Fax Number:
203-381-3001
Provider Enumeration Date:
03/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  12.009460 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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