Most Relevant Information
Provider Data
| NPI Number: | 1003425331 |
| Provider Name: | RYAN KEENAN PMHNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0808X |
| Specialty: | Nurse Practitioner |
| License Number: | 12.008970 |
Most Important Dates
| Enumeration Date: | 07/22/2020 |
| Last Updated: | 01/30/2022 |
Provider Practice Location
267 GRANT ST
BRIDGEPORT
CT
066102870
Practice Location Phone/Fax
| Phone: | 2033843000 |
| Fax: |
Provider Mailing Location
132 STONEWALL DR
HAMDEN
CT
065181123
Provider Mailing Phone/Fax
| Phone: | 2036050152 |
| Fax: |