Provider Demographics
NPI:1144695453
Name:COSBY, CATRECE (LPN)
Entity type:Individual
Prefix:
First Name:CATRECE
Middle Name:
Last Name:COSBY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CATRECE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:7431 SIELOFF DR
Mailing Address - Street 2:APT E
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2244
Mailing Address - Country:US
Mailing Address - Phone:314-718-1655
Mailing Address - Fax:
Practice Address - Street 1:7431 SIELOFF DR
Practice Address - Street 2:APT E
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2244
Practice Address - Country:US
Practice Address - Phone:314-718-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker