Provider Demographics
NPI:1720019805
Name:IGO, CATHERINE (CRNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:IGO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6213 BURGESS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-1829
Mailing Address - Country:US
Mailing Address - Phone:410-444-9481
Mailing Address - Fax:410-444-9482
Practice Address - Street 1:6213 BURGESS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-1829
Practice Address - Country:US
Practice Address - Phone:410-444-9481
Practice Address - Fax:410-444-9482
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR118052163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ33581Medicare UPIN
MD385SMedicare ID - Type Unspecified