MEDICARE: MS. KEISHA LANEE BRIDGETT STNA

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
1	376K00000X	Nurse's Aide	400552951106	OH

General Provider Information

NPI Number	:	1780938365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KEISHA LANEE BRIDGETT STNA

Provider Business Mailing Address
First Line	:	1729 PULTE ST
Second Line	:	FLOOR 1
City	:	CINCINNATI
State	:	OH
Zip	:	45225-1930
Country	:	US
Telephone Number	:	513-787-1418
Fax Number	:

Provider Business Practice Location Address
First Line	:	1729 PULTE ST
Second Line	:	FLOOR 1
City	:	CINCINNATI
State	:	OH
Zip	:	45225-1930
Country	:	US
Telephone Number	:	513-787-1418
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2012
Last Update Date	:	11/03/2012

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