Provider Demographics
NPI:1427501204
Name:DENNIS, KEISHA MARIA (LPN)
Entity type:Individual
Prefix:MISS
First Name:KEISHA
Middle Name:MARIA
Last Name:DENNIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 E 227TH ST
Mailing Address - Street 2:APT. 2K
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4623
Mailing Address - Country:US
Mailing Address - Phone:954-330-2593
Mailing Address - Fax:
Practice Address - Street 1:948 E 227TH ST
Practice Address - Street 2:APT. 2K
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4623
Practice Address - Country:US
Practice Address - Phone:954-330-2593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307040-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse