Provider Demographics
NPI:1598109399
Name:RINCON, CATHERINE ELAINE (LPN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ELAINE
Last Name:RINCON
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 1:2515 FAIROAK AVE
Mailing Address - Street 2:APT. 130
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1584
Mailing Address - Country:US
Mailing Address - Phone:612-408-7451
Mailing Address - Fax:
Practice Address - Street 1:2515 FAIROAK AVE
Practice Address - Street 2:APT. 130
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1584
Practice Address - Country:US
Practice Address - Phone:612-408-7451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL 73365-2164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN503383Medicaid