Provider Demographics
NPI:1407253164
Name:CRUZ, CATHERINE (LPN)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:
Last Name:CRUZ
Suffix:
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 1:740 N 25TH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-2615
Mailing Address - Country:US
Mailing Address - Phone:717-306-8395
Mailing Address - Fax:
Practice Address - Street 1:740 N 25TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-2615
Practice Address - Country:US
Practice Address - Phone:717-306-8395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN254568L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPN254568LOtherCOMMONWEALTH OF PA DEPARTMENT OF STATE BUREAU OF PROFESSIONAL AND OCCUPATIONAL A