Individual
TASHA KEITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
711 E 19TH ST, ERIE, PA 16503-2148
(814) 871-2605
Mailing address
711 E 19TH ST, ERIE, PA 16503-2148
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN278436
PA
Other
Enumeration date
03/13/2014
Last updated
03/13/2014
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