Provider Demographics
NPI:1477239671
Name:KEITH, NECOLE DENISE (DODD)
Entity Type:Individual
Prefix:MS
First Name:NECOLE
Middle Name:DENISE
Last Name:KEITH
Suffix:
Gender:F
Credentials:DODD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9910 GREENVIEW AVE # 1
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-1514
Mailing Address - Country:US
Mailing Address - Phone:216-507-1112
Mailing Address - Fax:
Practice Address - Street 1:9910 GREENVIEW AVE # 1
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-1514
Practice Address - Country:US
Practice Address - Phone:216-507-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1477239671372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider