Provider Demographics
NPI:1699109413
Name:KUEHL, DAWN RENEE
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:RENEE
Last Name:KUEHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 GALLEON LN
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-2096
Mailing Address - Country:US
Mailing Address - Phone:321-794-6637
Mailing Address - Fax:
Practice Address - Street 1:3130 S HWY A1A
Practice Address - Street 2:
Practice Address - City:MELBOURNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32951-4281
Practice Address - Country:US
Practice Address - Phone:321-725-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT8121183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RPT8121OtherSTATE OF FLORIDA LICENSE