Provider Demographics
NPI:1144621764
Name:NANCE, KEISHA (KEISHA)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:NANCE
Suffix:
Gender:F
Credentials:KEISHA
Other - Prefix:
Other - First Name:KEISHA
Other - Middle Name:
Other - Last Name:NANCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRANIAL PROSTHETICS
Mailing Address - Street 1:5510 HIGHWAY 53 STE UNITH
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-8590
Mailing Address - Country:US
Mailing Address - Phone:256-929-1939
Mailing Address - Fax:
Practice Address - Street 1:5510 HIGHWAY 53 STE H
Practice Address - Street 2:
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749-8594
Practice Address - Country:US
Practice Address - Phone:256-929-1939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL821956311OtherCRANIAL PROSTHETICS
AL$$$$$$$$$OtherCRANIAL PROSTHETICS