Provider Demographics
NPI:1083246854
Name:HANNAH, KEASHA (NURSING ASSISTANT)
Entity Type:Individual
Prefix:
First Name:KEASHA
Middle Name:
Last Name:HANNAH
Suffix:
Gender:F
Credentials:NURSING ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4139 W FOREST PARK AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-7408
Mailing Address - Country:US
Mailing Address - Phone:443-410-9544
Mailing Address - Fax:
Practice Address - Street 1:4139 W FOREST PARK AVE FL 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-7408
Practice Address - Country:US
Practice Address - Phone:443-410-9544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251J00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No251J00000XAgenciesNursing Care