Provider Demographics
NPI:1598878696
Name:PUTMAN, CATHRINE MAUREEN (CPED)
Entity Type:Individual
Prefix:MRS
First Name:CATHRINE
Middle Name:MAUREEN
Last Name:PUTMAN
Suffix:
Gender:F
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13320 E 36TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-5891
Mailing Address - Country:US
Mailing Address - Phone:928-345-9162
Mailing Address - Fax:
Practice Address - Street 1:11274 S FORTUNA RD
Practice Address - Street 2:SUITE C3
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-7847
Practice Address - Country:US
Practice Address - Phone:928-345-1907
Practice Address - Fax:928-345-1907
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20650335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier