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NPI Code Detail

MEDICARE: ALISSA R KEYSOR LPN

MEDICARE: ALISSA R KEYSOR LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse164075OH

General Provider Information

NPI Number : 1164041125
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALISSA R KEYSOR LPN
Provider Business Mailing Address
First Line : 417 PLYMOUTH ST APT A
Second Line :
City : PLYMOUTH
State : OH
Zip : 44865-1027
Country : US
Telephone Number : 419-515-9873
Fax Number :
Provider Business Practice Location Address
First Line : 475 LEXINGTON AVE
Second Line :
City : MANSFIELD
State : OH
Zip : 44907-1501
Country : US
Telephone Number : 419-419-5705
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2020
Last Update Date : 04/10/2020

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Directions to “ ALISSA R KEYSOR LPN” Practice Location

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