Provider Demographics
NPI:1942405634
Name:KEITH, GENEVA LEE (LPN)
Entity type:Individual
Prefix:MRS
First Name:GENEVA
Middle Name:LEE
Last Name:KEITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 JANELLE WAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-4400
Mailing Address - Country:US
Mailing Address - Phone:541-954-5143
Mailing Address - Fax:
Practice Address - Street 1:2534 JANELLE WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-4400
Practice Address - Country:US
Practice Address - Phone:541-954-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR618304OtherPROVIDER NUMBER