Provider Demographics
NPI:1740748532
Name:KEISCH, HARLEY (RN)
Entity Type:Individual
Prefix:MR
First Name:HARLEY
Middle Name:
Last Name:KEISCH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-8820
Mailing Address - Country:US
Mailing Address - Phone:239-248-6940
Mailing Address - Fax:
Practice Address - Street 1:197 VIEW DR
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-8820
Practice Address - Country:US
Practice Address - Phone:239-248-6940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2258432163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse