Provider Demographics
NPI:1447324298
Name:KEENAN, RORY MARY (CRNA)
Entity type:Individual
Prefix:
First Name:RORY
Middle Name:MARY
Last Name:KEENAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:RORY
Other - Middle Name:MARY
Other - Last Name:FERARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 DUARTE RD
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3012
Practice Address - Country:US
Practice Address - Phone:626-256-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA2808367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN4930810328OtherCALOPTIMA
CAWNA2808AMedicare ID - Type Unspecified
CAP69410Medicare UPIN
CARN4930810Medicaid