Provider Demographics
NPI:1861679649
Name:LUTTENEGGER KAUSCH, THERESA A (NNP)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:A
Last Name:LUTTENEGGER KAUSCH
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BLYTHE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28232-2861
Mailing Address - Country:US
Mailing Address - Phone:704-355-1210
Mailing Address - Fax:704-355-1221
Practice Address - Street 1:1000 BLYTHE BOULEVARD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28232-2861
Practice Address - Country:US
Practice Address - Phone:704-355-1210
Practice Address - Fax:704-355-1221
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC155961364SN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SN0000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeonatal