Individual
TYNAE DOMINIQUE KEITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5814 PINE ST, PHILADELPHIA, PA 19143-1218
(267) 504-2464
(267) 292-4893
Mailing address
5814 PINE ST, PHILADELPHIA, PA 19143-1218
(267) 504-2464
(267) 292-4893
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
37183601
PA
Other
Enumeration date
07/24/2018
Last updated
07/24/2018
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