Provider Demographics
NPI:1790454197
Name:SALISBURY, CATHLEEN LYNN
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:LYNN
Last Name:SALISBURY
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 1:3021 AARONS FORK RD
Mailing Address - Street 2:
Mailing Address - City:ELKVIEW
Mailing Address - State:WV
Mailing Address - Zip Code:25071-6014
Mailing Address - Country:US
Mailing Address - Phone:304-553-6628
Mailing Address - Fax:
Practice Address - Street 1:3021 AARONS FORK RD
Practice Address - Street 2:
Practice Address - City:ELKVIEW
Practice Address - State:WV
Practice Address - Zip Code:25071-6014
Practice Address - Country:US
Practice Address - Phone:304-553-6628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant