Provider Demographics
NPI:1073745691
Name:KEIS, TERI MICHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:MICHELLE
Last Name:KEIS
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 1:148 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ALLEGANY
Mailing Address - State:NY
Mailing Address - Zip Code:14706-1047
Mailing Address - Country:US
Mailing Address - Phone:716-372-2763
Mailing Address - Fax:
Practice Address - Street 1:148 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ALLEGANY
Practice Address - State:NY
Practice Address - Zip Code:14706-1047
Practice Address - Country:US
Practice Address - Phone:716-372-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-15
Last Update Date:2009-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283357-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse