Provider Demographics
NPI:1164069670
Name:MAXI, CATHY (RN)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:
Last Name:MAXI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 RIVER ST APT 214
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-3290
Mailing Address - Country:US
Mailing Address - Phone:978-855-1416
Mailing Address - Fax:
Practice Address - Street 1:245 RIVER ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-3282
Practice Address - Country:US
Practice Address - Phone:978-878-8300
Practice Address - Fax:978-627-8349
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2290081163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANEXTIVAFAX.COMMedicaid