Provider Demographics
NPI:1861258907
Name:STEIN, KEIANNA
Entity type:Individual
Prefix:
First Name:KEIANNA
Middle Name:
Last Name:STEIN
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 1:14120 47TH LN NW
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-8619
Mailing Address - Country:US
Mailing Address - Phone:701-651-2817
Mailing Address - Fax:
Practice Address - Street 1:14120 47TH LN NW
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-8619
Practice Address - Country:US
Practice Address - Phone:701-651-2817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes132700000XDietary & Nutritional Service ProvidersDietary Manager