Provider Demographics
NPI:1740898956
Name:DUCHAINE, KATHI ELIZABETH (CNM)
Entity type:Individual
Prefix:
First Name:KATHI
Middle Name:ELIZABETH
Last Name:DUCHAINE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 N WICKHAM RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2322
Mailing Address - Country:US
Mailing Address - Phone:321-775-3334
Mailing Address - Fax:
Practice Address - Street 1:3150 N WICKHAM RD STE 1
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2322
Practice Address - Country:US
Practice Address - Phone:321-775-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006445367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife