Provider Demographics
NPI:1780640581
Name:LASSITER, CATHY SUE
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:SUE
Last Name:LASSITER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:SUE
Other - Last Name:ELKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1118 MAYLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CUTLER
Mailing Address - State:OH
Mailing Address - Zip Code:45724
Mailing Address - Country:US
Mailing Address - Phone:740-551-9580
Mailing Address - Fax:
Practice Address - Street 1:1118 MAYLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:CUTLER
Practice Address - State:OH
Practice Address - Zip Code:45724
Practice Address - Country:US
Practice Address - Phone:740-551-9580
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2202753Medicaid