Provider Demographics
NPI:1699249268
Name:RORIE, KEISHA
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:RORIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 EWING PL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-4959
Mailing Address - Country:US
Mailing Address - Phone:757-581-9634
Mailing Address - Fax:
Practice Address - Street 1:1828 EWING PL
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-4959
Practice Address - Country:US
Practice Address - Phone:757-581-9634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA67284376172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver