Provider Demographics
NPI:1730588963
Name:KEEN, JOEL (LPN)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:KEEN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 859
Mailing Address - Street 2:172 SPRUCE DRIVE
Mailing Address - City:OLD FORGE
Mailing Address - State:NY
Mailing Address - Zip Code:13420-0859
Mailing Address - Country:US
Mailing Address - Phone:315-355-1789
Mailing Address - Fax:
Practice Address - Street 1:172 SPRUCE DRIVE
Practice Address - Street 2:
Practice Address - City:THENDARA
Practice Address - State:NY
Practice Address - Zip Code:13472
Practice Address - Country:US
Practice Address - Phone:315-355-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315015164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse