Provider Demographics
NPI:1477524353
Name:CASE, CATHLEEN K (NP)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:K
Last Name:CASE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NEPONSET ST FL ST12
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-595-2655
Mailing Address - Fax:508-425-5220
Practice Address - Street 1:5 NEPONSET ST FL STREET12
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2714
Practice Address - Country:US
Practice Address - Phone:508-595-2655
Practice Address - Fax:508-425-5220
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA117912363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0327352Medicaid
MANP0721Medicare PIN
MA0327352Medicaid