Provider Demographics
NPI:1477208395
Name:KEAHEY, TANGELA MONIQUE (LPN)
Entity Type:Individual
Prefix:
First Name:TANGELA
Middle Name:MONIQUE
Last Name:KEAHEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 ROCKCRESS DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-9238
Mailing Address - Country:US
Mailing Address - Phone:419-450-6630
Mailing Address - Fax:
Practice Address - Street 1:350 SOUTH IRWIN ROAD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43528
Practice Address - Country:US
Practice Address - Phone:567-703-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.176066164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse