Provider Demographics
NPI:1225734213
Name:KEELING, DORETHA (LPN)
Entity Type:Individual
Prefix:
First Name:DORETHA
Middle Name:
Last Name:KEELING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:DORETHA
Other - Middle Name:
Other - Last Name:KEELING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:308 RYERSON AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07502-1118
Mailing Address - Country:US
Mailing Address - Phone:973-932-8459
Mailing Address - Fax:
Practice Address - Street 1:21 US HIGHWAY 206
Practice Address - Street 2:
Practice Address - City:STANHOPE
Practice Address - State:NJ
Practice Address - Zip Code:07874-3275
Practice Address - Country:US
Practice Address - Phone:800-805-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP04922500164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse