Provider Demographics
NPI:1053204446
Name:MORA, KEESHIA GARCIA (LPN)
Entity type:Individual
Prefix:
First Name:KEESHIA
Middle Name:GARCIA
Last Name:MORA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KEESHIA
Other - Middle Name:GARCIA
Other - Last Name:SINGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:13 PARKWOOD DR APT 13F
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2301
Mailing Address - Country:US
Mailing Address - Phone:862-212-2951
Mailing Address - Fax:
Practice Address - Street 1:901 ERNSTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-2000
Practice Address - Country:US
Practice Address - Phone:732-585-1815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP07755400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty