Provider Demographics
NPI:1174520365
Name:KUSCHNER, JACQUELINE (CPM, LM)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:KUSCHNER
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7932 HONEY FIG RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1961
Mailing Address - Country:US
Mailing Address - Phone:980-245-7458
Mailing Address - Fax:
Practice Address - Street 1:7932 HONEY FIG RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-1961
Practice Address - Country:US
Practice Address - Phone:980-245-7458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLMW-0056176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM901Medicare ID - Type Unspecified
P34791Medicare UPIN