Provider Demographics
NPI:1174352165
Name:LETT, KEIV
Entity type:Individual
Prefix:
First Name:KEIV
Middle Name:
Last Name:LETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 E AUBURNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44507-1902
Mailing Address - Country:US
Mailing Address - Phone:330-423-7784
Mailing Address - Fax:
Practice Address - Street 1:136 E AUBURNDALE AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507-1902
Practice Address - Country:US
Practice Address - Phone:330-423-7784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide