Provider Demographics
NPI:1356501233
Name:DODGE, CATHERINE P (RN)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:P
Last Name:DODGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:P
Other - Last Name:DODGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:6 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3427
Mailing Address - Country:US
Mailing Address - Phone:631-849-3426
Mailing Address - Fax:
Practice Address - Street 1:6 18TH ST
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3427
Practice Address - Country:US
Practice Address - Phone:631-849-3426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY376230-1163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7423123Medicaid