Provider Demographics
NPI:1760664577
Name:CATLIN, LISA SIMONE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SIMONE
Last Name:CATLIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 STOWE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1706
Mailing Address - Country:US
Mailing Address - Phone:516-223-1699
Mailing Address - Fax:
Practice Address - Street 1:678 STOWE AVE
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1706
Practice Address - Country:US
Practice Address - Phone:516-223-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY527415-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse