Provider Demographics
NPI:1346422342
Name:MCCORMICK, CATHERYN LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:CATHERYN
Middle Name:LYNN
Last Name:MCCORMICK
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 1:1868 NEWTON RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-9753
Mailing Address - Country:US
Mailing Address - Phone:719-251-7365
Mailing Address - Fax:
Practice Address - Street 1:1868 NEWTON RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-9753
Practice Address - Country:US
Practice Address - Phone:719-251-7365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN168900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse