Provider Demographics
NPI:1245577154
Name:WANTUCH, KAREN D (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:D
Last Name:WANTUCH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:D
Other - Last Name:RATHWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:281 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-3126
Practice Address - Country:US
Practice Address - Phone:828-245-6400
Practice Address - Fax:828-245-3838
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC169316363LF0000X
NCF0712525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7006658Medicaid
NCNCB931A2342423AOtherMEDICARE PIN
NCNCB931A2342423AOtherMEDICARE PIN