Provider Demographics
NPI:1659174381
Name:ETSE, KEZIAH PRECIOUS ANNABELLE II
Entity type:Individual
Prefix:MRS
First Name:KEZIAH
Middle Name:PRECIOUS ANNABELLE
Last Name:ETSE
Suffix:II
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 1:9126 BLACK ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1823
Mailing Address - Country:US
Mailing Address - Phone:531-772-1590
Mailing Address - Fax:531-201-4505
Practice Address - Street 1:9126 BLACK ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1823
Practice Address - Country:US
Practice Address - Phone:531-772-1590
Practice Address - Fax:531-201-4505
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care