Individual
WAVANEY M KETTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
11709 HOLLY CREEK DR, RIVERVIEW, FL 33569-2018
(813) 569-9601
(813) 609-6784
Mailing address
11709 HOLLY CREEK DR, RIVERVIEW, FL 33569-2018
(813) 569-9601
(813) 609-6784
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
RN9179030
FL
174H00000X
Health Educator
Primary
RN9179030
FL
Other
Enumeration date
09/13/2016
Last updated
09/13/2016
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