Provider Demographics
NPI:1437620846
Name:NELSON, CATHERINE LUCY
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LUCY
Last Name:NELSON
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 1:56 BOWER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3662
Mailing Address - Country:US
Mailing Address - Phone:978-578-3857
Mailing Address - Fax:
Practice Address - Street 1:56 BOWER ST APT 1
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3662
Practice Address - Country:US
Practice Address - Phone:978-578-3857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2312661163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2312661OtherNURSING LICENSE