Provider Demographics
NPI:1124798053
Name:KEENAN, AMANDA LEE (CRNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:KEENAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:HEBERLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:8100 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:PA
Mailing Address - Zip Code:19507-9707
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:
Practice Address - Street 1:720 NORMAN DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7481
Practice Address - Country:US
Practice Address - Phone:717-639-3230
Practice Address - Fax:717-274-1659
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022593363LF0000X
PARN660162163W00000X
PAMK7819088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse