Provider Demographics
NPI:1124618673
Name:FETTNER, KAREN (RN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:FETTNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11903 SW WOOD STORK WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-5310
Mailing Address - Country:US
Mailing Address - Phone:954-448-6006
Mailing Address - Fax:772-242-1736
Practice Address - Street 1:11903 SW WOOD STORK WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-5310
Practice Address - Country:US
Practice Address - Phone:954-448-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1559802163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency