Healthcare Provider Details

I. General information

NPI: 1174520365
Provider Name (Legal Business Name): JACQUELINE KUSCHNER CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7932 HONEY FIG RD
CHARLOTTE NC
28277-1961
US

IV. Provider business mailing address

7932 HONEY FIG RD
CHARLOTTE NC
28277-1961
US

V. Phone/Fax

Practice location:
  • Phone: 980-245-7458
  • Fax:
Mailing address:
  • Phone: 980-245-7458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLMW-0056
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: