Provider Demographics
NPI:1417146135
Name:MARS, CATHERINE ELIZABETH (LPN)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:ELIZABETH
Last Name:MARS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:CATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:SAKOVITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:642 SOUTH MAIN STREET
Mailing Address - Street 2:APT 3
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1784
Mailing Address - Country:US
Mailing Address - Phone:570-702-7404
Mailing Address - Fax:
Practice Address - Street 1:642 SOUTH MAIN STREET
Practice Address - Street 2:APT 3
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1784
Practice Address - Country:US
Practice Address - Phone:570-702-7404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2854231164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02908969Medicaid