Provider Demographics
NPI:1386982486
Name:REILLY, CATHERINE MARIE (RN, FCPI)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARIE
Last Name:REILLY
Suffix:
Gender:F
Credentials:RN, FCPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 URBY DR
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2330
Mailing Address - Country:US
Mailing Address - Phone:410-852-2089
Mailing Address - Fax:
Practice Address - Street 1:1749 URBY DR
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2330
Practice Address - Country:US
Practice Address - Phone:410-852-2089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO54423174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator