MEDICARE: MRS. DAWN RENEE KUEHL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	RPT8121	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RPT8121	OTHER		STATE OF FLORIDA LICENSE

General Provider Information

NPI Number	:	1699109413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAWN RENEE KUEHL

Provider Business Mailing Address
First Line	:	3123 GALLEON LN
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-2096
Country	:	US
Telephone Number	:	321-794-6637
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 S HWY A1A
Second Line	:
City	:	MELBOURNE BEACH
State	:	FL
Zip	:	32951-4281
Country	:	US
Telephone Number	:	321-725-3711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	08/28/2013

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