Provider Demographics
NPI:1538794680
Name:O'KEEFE, DOROTHY A
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:A
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MOOSEHEAD TRL STE 5
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-4056
Mailing Address - Country:US
Mailing Address - Phone:207-368-5189
Mailing Address - Fax:
Practice Address - Street 1:118 MOOSEHEAD TRL STE 5
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953-4056
Practice Address - Country:US
Practice Address - Phone:207-368-5189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP191230363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health