Provider Demographics
NPI:1376226977
Name:LOUTZENHEISER, JACQUELINE KAY (PA-C)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:KAY
Last Name:LOUTZENHEISER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:LOUTZENHEISER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3500 CHAD DRIVE STE 300, EUGENE OREGON 97408
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408
Mailing Address - Country:US
Mailing Address - Phone:541-687-5443
Mailing Address - Fax:541-683-1422
Practice Address - Street 1:520 COUNTRY CLUB ROAD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-683-5001
Practice Address - Fax:541-683-1422
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA217062363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant