Keith, Mary Jeanne

Keith, Mary Jeanne is an sole proprietor health care provider with primary practice located at 401 Carlson Parkway Cp340, Minnetonka MN 55305-5387. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Gerontology, which is considered as her primary health care specialty. Keith, Mary Jeanne can be contacted via phone (952) 992-3604.

Contact Information

Primary practice address
401 Carlson Parkway Cp340 Minnetonka MN 55305-5387
Fax: (612) 866-0459
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 136908-23 Maryland

Profile Details

NPI number 1396733739
LBN Legal business name Keith, Mary Jeanne
Credentials RN, CNP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 10th, 2005
Last updated Sep 7th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396733739 NPPES
Minnesota MEDICAID 553215900

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