Provider Demographics
NPI:1184179327
Name:SHANLEY, CATHERINE MARGARET SR (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:MARGARET
Last Name:SHANLEY
Suffix:SR
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ELK DR APT B17
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-5208
Mailing Address - Country:US
Mailing Address - Phone:845-417-4261
Mailing Address - Fax:
Practice Address - Street 1:9 ELK DR APT B17
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-5208
Practice Address - Country:US
Practice Address - Phone:845-417-4261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203787-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse