Basic Information
| Provider Information | |||||||||
| NPI: | 1457751158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEYES | ||||||||
| FirstName: | IVRINA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LVN-215505 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1007 MYRTLE AVENUE | ||||||||
| Address2: | |||||||||
| City: | INGLEWOOD, | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104124191 | ||||||||
| FaxNumber: | 3104123942 | ||||||||
| Practice Location | |||||||||
| Address1: | 1007 MYRTLE AVE | ||||||||
| Address2: | |||||||||
| City: | INGLEWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 903014009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104124191 | ||||||||
| FaxNumber: | 3104123942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2014 | ||||||||
| LastUpdateDate: | 08/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN215505 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.