Provider Demographics
NPI:1700028552
Name:CORLEW, CATHIE PATRICIA (LVN)
Entity Type:Individual
Prefix:MS
First Name:CATHIE
Middle Name:PATRICIA
Last Name:CORLEW
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13906 FIJI WAY
Mailing Address - Street 2:350
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6959
Mailing Address - Country:US
Mailing Address - Phone:310-822-2724
Mailing Address - Fax:
Practice Address - Street 1:13906 FIJI WAY
Practice Address - Street 2:APT NO 350
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6959
Practice Address - Country:US
Practice Address - Phone:310-822-2724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN234950164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse