Provider Demographics
NPI:1518555390
Name:VIGIL, CATHERINE M (LPN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:VIGIL
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 1:349 N BENITO DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1181
Mailing Address - Country:US
Mailing Address - Phone:719-821-0166
Mailing Address - Fax:
Practice Address - Street 1:349 N BENITO DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-1181
Practice Address - Country:US
Practice Address - Phone:719-821-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPN0033647164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS614382300OtherOWCP FECA