Provider Demographics
NPI:1730157843
Name:KEENAN, JOHN GEORGE (CRNA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GEORGE
Last Name:KEENAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 HERMES ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-2722
Mailing Address - Country:US
Mailing Address - Phone:619-423-4200
Mailing Address - Fax:
Practice Address - Street 1:34800 W. BOB WILSON DRIVE
Practice Address - Street 2:NMCSD ANESTHESIA DEPARTMENT
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134
Practice Address - Country:US
Practice Address - Phone:619-532-8942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 559071163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine