Provider Demographics
NPI:1366022865
Name:KVANDE, KEITH ALAN
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ALAN
Last Name:KVANDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 5TH AVE W # 23
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-3432
Mailing Address - Country:US
Mailing Address - Phone:701-770-3313
Mailing Address - Fax:
Practice Address - Street 1:1805 5TH AVE W # 23
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3432
Practice Address - Country:US
Practice Address - Phone:701-770-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant