Provider Demographics
NPI:1073312856
Name:KEYES, ANDREA ANNETTA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ANNETTA
Last Name:KEYES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:ANNETTA
Other - Last Name:KEYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6106 JAYNES ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-1635
Mailing Address - Country:US
Mailing Address - Phone:402-415-4014
Mailing Address - Fax:
Practice Address - Street 1:6106 JAYNES ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-1635
Practice Address - Country:US
Practice Address - Phone:402-415-4014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider