Individual
MRS. GENEVA LEE KEITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2534 JANELLE WAY, EUGENE, OR 97404-4400
(541) 954-5143
Mailing address
2534 JANELLE WAY, EUGENE, OR 97404-4400
(541) 954-5143
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
618304
PROVIDER NUMBER
OR
Enumeration date
06/20/2007
Last updated
07/08/2007
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