Healthcare Provider Details

I. General information

NPI: 1790736270
Provider Name (Legal Business Name): CHRISTINE KOTOUCH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWTHORNE LN
CHARLOTTE NC
28204-2515
US

IV. Provider business mailing address

PO BOX 65849
CHARLOTTE NC
28265-0849
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-4239
  • Fax: 704-384-5636
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number027860
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: