Provider Demographics
NPI:1740730803
Name:MCDONALD, CATHY COSTLOW (RN)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:COSTLOW
Last Name:MCDONALD
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 1:1400A E 20TH ST
Mailing Address - Street 2:EXCEPTIONAL PROGRAMS OFFICE
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-9024
Mailing Address - Country:US
Mailing Address - Phone:505-599-8762
Mailing Address - Fax:505-599-8796
Practice Address - Street 1:1400A E 20TH ST
Practice Address - Street 2:EXCEPTIONAL PROGRAMS OFFICE
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-9024
Practice Address - Country:US
Practice Address - Phone:505-599-8762
Practice Address - Fax:505-599-8796
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2190163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR25190OtherRN LICENSE