Provider Demographics
NPI:1790201259
Name:MCCORMICK, KATHLEEN M (LVN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:LEMMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:25402 PACIFICA AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-238-2400
Mailing Address - Fax:949-860-7924
Practice Address - Street 1:25402 PACIFICA AVE
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-238-2400
Practice Address - Fax:949-860-7924
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279472164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse