Provider Demographics
NPI:1720343544
Name:BASEL, CATHERINE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARIE
Last Name:BASEL
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 1:944 SLATE DRIVE BRUNSWICK
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212
Mailing Address - Country:US
Mailing Address - Phone:330-460-0048
Mailing Address - Fax:
Practice Address - Street 1:944 SLATE DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-6273
Practice Address - Country:US
Practice Address - Phone:330-460-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.127891164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN.127891OtherOHIO BOARD OF NURSING