Provider Demographics
NPI:1659706323
Name:KEITH, LAURA (LPN)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:KEITH
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 1:18 MARYLAND ST
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6834
Mailing Address - Country:US
Mailing Address - Phone:631-243-0093
Mailing Address - Fax:
Practice Address - Street 1:18 MARYLAND ST
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6834
Practice Address - Country:US
Practice Address - Phone:631-243-0093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315780-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse