Provider Demographics
NPI:1336542166
Name:CORDIAL, CATHY CECILE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:CECILE
Last Name:CORDIAL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 HIGHWAY 25 E
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-8303
Mailing Address - Country:US
Mailing Address - Phone:864-430-3667
Mailing Address - Fax:
Practice Address - Street 1:137 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3535
Practice Address - Country:US
Practice Address - Phone:423-774-3916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000025139164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse