Provider Demographics
NPI:1972240497
Name:HITZEMAN, KEBA
Entity Type:Individual
Prefix:
First Name:KEBA
Middle Name:
Last Name:HITZEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 STATE ROUTE 718
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45359-9701
Mailing Address - Country:US
Mailing Address - Phone:937-474-2476
Mailing Address - Fax:
Practice Address - Street 1:8230 STATE ROUTE 718
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:OH
Practice Address - Zip Code:45359-9701
Practice Address - Country:US
Practice Address - Phone:937-474-2476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant