Provider Demographics
NPI:1154407021
Name:KEUNE, DAVID MARK (CRNFA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MARK
Last Name:KEUNE
Suffix:
Gender:M
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 SUMMER OAK COURT
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5968
Mailing Address - Country:US
Mailing Address - Phone:636-230-5023
Mailing Address - Fax:636-230-3631
Practice Address - Street 1:810 SUMMER OAK CT
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63021-5968
Practice Address - Country:US
Practice Address - Phone:636-230-5023
Practice Address - Fax:636-230-3631
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO066589163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant