Individual
KEANU BEN TOHANNIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CERTIFIED MEDICAL AS
Contact information
Practice address
167 NORTH MAIN STREET, TUBA CITY, AZ 86045-0600
(928) 283-2094
(928) 283-2677
Mailing address
PO BOX 600, TUBA CITY, AZ 86045-0600
(928) 283-2094
(928) 283-2677
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
E8L6X2B3
TX
Other
Enumeration date
12/07/2015
Last updated
01/05/2016
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