Provider Demographics
NPI:1750875175
Name:HUIE, KEISHA A (LPN)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:A
Last Name:HUIE
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 1:79 RAY AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1841
Mailing Address - Country:US
Mailing Address - Phone:516-587-7710
Mailing Address - Fax:
Practice Address - Street 1:79 RAY AVENUE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-1481
Practice Address - Country:US
Practice Address - Phone:516-587-7710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304509164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY304509OtherLPN LICENSE