MEDICARE: KEEANDREA LEE GRIFFIN

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	372600000X	Adult Companion

General Provider Information

NPI Number	:	1932943388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEEANDREA LEE GRIFFIN

Provider Business Mailing Address
First Line	:	665 SPRING ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608-2551
Country	:	US
Telephone Number	:	419-381-4985
Fax Number	:	419-214-8287

Provider Business Practice Location Address
First Line	:	665 SPRING ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608-2551
Country	:	US
Telephone Number	:	419-381-4985
Fax Number	:	419-214-8287

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

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	06/20/2024

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