Healthcare Provider Details

I. General information

NPI: 1861679649
Provider Name (Legal Business Name): THERESA A LUTTENEGGER NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BOULEVARD
CHARLOTTE NC
28232-2861
US

IV. Provider business mailing address

1000 BLYTHE BOULEVARD
CHARLOTTE NC
28232-2861
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-1210
  • Fax: 704-355-1221
Mailing address:
  • Phone: 704-355-1210
  • Fax: 704-355-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SN0000X
TaxonomyNeonatal Clinical Nurse Specialist
License Number155961
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: