Provider Demographics
NPI:1700967114
Name:HIMEL, KEITH L (LPN)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:L
Last Name:HIMEL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19430 105TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-6486
Mailing Address - Country:US
Mailing Address - Phone:253-227-1882
Mailing Address - Fax:253-589-4150
Practice Address - Street 1:OF VETERANS AFFAIRS
Practice Address - Street 2:PSHCS, AMERICAN LAKE DIVISION, ER
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-5000
Practice Address - Country:US
Practice Address - Phone:253-582-8440
Practice Address - Fax:253-589-4150
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00048942164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse