Provider Demographics
NPI:1336561471
Name:CANALE, CATHERINE CALDWELL (RN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:CALDWELL
Last Name:CANALE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-1408
Mailing Address - Country:US
Mailing Address - Phone:901-647-2567
Mailing Address - Fax:
Practice Address - Street 1:1487 W KEISER AVE STE I
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370-2806
Practice Address - Country:US
Practice Address - Phone:870-563-4500
Practice Address - Fax:870-563-4501
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR095058163WP0807X
ARRTP-013866163WP0807X
TNRN0000065843163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent