Provider Demographics
NPI:1124470364
Name:CATHCART, KATIE (LVN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:CATHCART
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 W VALLEY PKWY
Mailing Address - Street 2:STE 102
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-2549
Mailing Address - Country:US
Mailing Address - Phone:858-385-9399
Mailing Address - Fax:760-294-9603
Practice Address - Street 1:613 W VALLEY PKWY
Practice Address - Street 2:STE 102
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-2549
Practice Address - Country:US
Practice Address - Phone:858-385-9399
Practice Address - Fax:760-294-9603
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282582164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse