Provider Demographics
NPI:1255357919
Name:MAINE, CATHY L (FNP)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:L
Last Name:MAINE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 MEDICAL PARK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-1100
Mailing Address - Country:US
Mailing Address - Phone:276-378-3300
Mailing Address - Fax:276-378-1265
Practice Address - Street 1:245 MEDICAL PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-1100
Practice Address - Country:US
Practice Address - Phone:276-378-3300
Practice Address - Fax:276-378-1265
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024164690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1255357919Medicaid
TNQ008366Medicaid
VAVVH080AMedicare PIN
VA1255357919Medicaid
VA010180015Medicaid
TN0102OtherJOHN DEERE
VAC09538Medicare PIN