Provider Demographics
NPI:1669587804
Name:BLESS, CATHY D (APN)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:D
Last Name:BLESS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:D
Other - Last Name:MCGOWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:109 CALIFORNIA ST
Mailing Address - Street 2:PO BOX 577
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-0577
Mailing Address - Country:US
Mailing Address - Phone:618-985-8221
Mailing Address - Fax:618-985-4635
Practice Address - Street 1:1006 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-1539
Practice Address - Country:US
Practice Address - Phone:618-985-4841
Practice Address - Fax:618-985-8101
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002890363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209-002890OtherSTATE LICENSE NUMBER
IL370966854004Medicaid
IL370966854015Medicaid
ILCF3444OtherMEDICARE RR
IL073080OtherHEALTH ALLIANCE
IL370966854015Medicaid
IL141816Medicare Oscar/Certification
IL370966854004Medicaid