Provider Demographics
NPI:1093319485
Name:KEEN, DAISY MAE
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:MAE
Last Name:KEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAISY
Other - Middle Name:MAE
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1098 LITTLE ITALY RD
Mailing Address - Street 2:
Mailing Address - City:IVYDALE
Mailing Address - State:WV
Mailing Address - Zip Code:25113-8107
Mailing Address - Country:US
Mailing Address - Phone:304-286-4334
Mailing Address - Fax:
Practice Address - Street 1:15 BANK ST
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:WV
Practice Address - Zip Code:25043
Practice Address - Country:US
Practice Address - Phone:304-587-9992
Practice Address - Fax:304-587-9993
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant