Provider Demographics
NPI:1235322306
Name:MEHMERT, CATHERINE A
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:MEHMERT
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 1:5445 AVENUE O
Mailing Address - Street 2:FORT MADISON COMMUNITY HOSPITAL
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627
Mailing Address - Country:US
Mailing Address - Phone:319-376-2230
Mailing Address - Fax:
Practice Address - Street 1:5445 AVENUE O
Practice Address - Street 2:FORT MADISON COMMUNITY HOSPITAL
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627
Practice Address - Country:US
Practice Address - Phone:319-376-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01170133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00104503OtherRAILROAD MEDICARE
IAI6066Medicare PIN
IAP00104503OtherRAILROAD MEDICARE