Provider Demographics
NPI:1104032010
Name:SACKETT, CATHERINE S (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:S
Last Name:SACKETT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11420 MANOR RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ARM
Mailing Address - State:MD
Mailing Address - Zip Code:21057-9412
Mailing Address - Country:US
Mailing Address - Phone:410-882-9845
Mailing Address - Fax:410-663-0451
Practice Address - Street 1:5600 NATHAN SHOCK DR
Practice Address - Street 2:GRC HANDLS
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6825
Practice Address - Country:US
Practice Address - Phone:410-558-8015
Practice Address - Fax:410-558-8019
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR051350363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health