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General NPI Number Information
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NPI Number | 1578224150
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Entity Type | Individual
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Provider Name | KETENA D LOUINE
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Gender | Female
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Dates
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Enumeration Date | 01/05/2022
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 605 SW INDIAN KEY DR
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-2076
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Country | US
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Telephone | 772-480-3776
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Fax |
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Provider Business Mailing Address
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Address Line | 605 SW INDIAN KEY DR
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-2076
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Country | US
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Telephone | 772-480-3776
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP3333312
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | NP3333312
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License Number State | FL
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