Healthcare Provider Details

I. General information

NPI: 1023519451
Provider Name (Legal Business Name): KATARZYNA ANNA QUTERMOUS MSN, CNL, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 LAKE CONCORD RD NE
CONCORD NC
28025-2925
US

IV. Provider business mailing address

11016 HERITAGE GREEN DR
CORNELIUS NC
28031-7408
US

V. Phone/Fax

Practice location:
  • Phone: 704-784-4494
  • Fax:
Mailing address:
  • Phone: 704-408-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number193053
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5010306
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: