Provider Demographics
NPI:1871867986
Name:KLUTTZ, LISA A
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:KLUTTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 COGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-5118
Mailing Address - Country:US
Mailing Address - Phone:704-750-9335
Mailing Address - Fax:877-239-8685
Practice Address - Street 1:216 COGGINS AVE
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-5118
Practice Address - Country:US
Practice Address - Phone:704-750-9335
Practice Address - Fax:877-239-8685
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 1744G0900X
NC1744R1103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder
No174400000XOther Service ProvidersSpecialist
No1744G0900XOther Service ProvidersSpecialistGraphics Designer