Basic Information
| Provider Information | |||||||||
| NPI: | 1669959425 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KATEREGGA | ||||||||
| FirstName: | VIVIANNE | ||||||||
| MiddleName: | KIGGUNDU | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KATEREGGA | ||||||||
| OtherFirstName: | VIVIANNE | ||||||||
| OtherMiddleName: | KIGGUNDU | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | APRN | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 13813 METRO PKWY | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339124343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393080005 | ||||||||
| FaxNumber: | 2397718578 | ||||||||
| Practice Location | |||||||||
| Address1: | 13813 METRO PKWY | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339124343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393080005 | ||||||||
| FaxNumber: | 2397718578 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2018 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 9256111 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207Q00000X | APRN9256111 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.