Provider Demographics
NPI:1760843874
Name:CUSIMANO, CATHERINE ELAINE
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ELAINE
Last Name:CUSIMANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 10TH AVE S
Mailing Address - Street 2:SUITE 444
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1200
Mailing Address - Country:US
Mailing Address - Phone:205-297-9801
Mailing Address - Fax:
Practice Address - Street 1:2700 10TH AVE S
Practice Address - Street 2:SUITE 444
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1200
Practice Address - Country:US
Practice Address - Phone:205-297-9801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-134271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily