Provider Demographics
NPI:1073926119
Name:LAUTERWASSER, WILLIAM A
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:LAUTERWASSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 POOLES CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:KY
Mailing Address - Zip Code:41076-8637
Mailing Address - Country:US
Mailing Address - Phone:859-653-8998
Mailing Address - Fax:
Practice Address - Street 1:409 POOLES CREEK RD
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-8637
Practice Address - Country:US
Practice Address - Phone:859-653-8998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2366425Medicaid