Provider Demographics
NPI:1780892828
Name:NIX, CATHERINE SUE (RN)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SUE
Last Name:NIX
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 1:2219 SKYHAWK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-7760
Mailing Address - Country:US
Mailing Address - Phone:260-749-0388
Mailing Address - Fax:
Practice Address - Street 1:2219 SKYHAWK DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7760
Practice Address - Country:US
Practice Address - Phone:260-749-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28164050A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse