Provider Demographics
NPI:1639692718
Name:PADEN, CATHY LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:LYNN
Last Name:PADEN
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:PO BOX 13783
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44334-3783
Mailing Address - Country:US
Mailing Address - Phone:330-417-2408
Mailing Address - Fax:
Practice Address - Street 1:15 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-2904
Practice Address - Country:US
Practice Address - Phone:234-678-5720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LPN.163659.MEDS-IV133V00000X
OHLPN.163659.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered