Provider Demographics
NPI:1245483577
Name:KEA, JANICE FAY
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:FAY
Last Name:KEA
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 1:1920 FORANE ST
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-5717
Mailing Address - Country:US
Mailing Address - Phone:760-380-3185
Mailing Address - Fax:
Practice Address - Street 1:1920 FORANE ST
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-5717
Practice Address - Country:US
Practice Address - Phone:760-380-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA221035164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse