Healthcare Provider Details

I. General information

NPI: 1861258907
Provider Name (Legal Business Name): KEIANNA STEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14120 47TH LN NW
WILLISTON ND
58801-8619
US

IV. Provider business mailing address

14120 47TH LN NW
WILLISTON ND
58801-8619
US

V. Phone/Fax

Practice location:
  • Phone: 701-651-2817
  • Fax:
Mailing address:
  • Phone: 701-651-2817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: