Healthcare Provider Details

I. General information

NPI: 1134958556
Provider Name (Legal Business Name): LUNIE ELISABETH WENSEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LUNIE LATORTUE

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 SANTA BARBARA BLVD STE 102
CAPE CORAL FL
33991-2038
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-424-1900
  • Fax: 239-424-1908
Mailing address:
  • Phone: 239-424-1900
  • Fax: 239-424-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11034250
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: