Provider Demographics
NPI:1932943388
Name:GRIFFIN, KEEANDREA LEE
Entity type:Individual
Prefix:
First Name:KEEANDREA
Middle Name:LEE
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2551
Mailing Address - Country:US
Mailing Address - Phone:419-381-4985
Mailing Address - Fax:419-214-8287
Practice Address - Street 1:665 SPRING ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2551
Practice Address - Country:US
Practice Address - Phone:419-381-4985
Practice Address - Fax:419-214-8287
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion