Provider Demographics
NPI:1487311775
Name:DDIBA, CATHERINE N (RN)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:N
Last Name:DDIBA
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 1:7224 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3462
Mailing Address - Country:US
Mailing Address - Phone:978-930-5661
Mailing Address - Fax:
Practice Address - Street 1:7224 AVALON DR
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3462
Practice Address - Country:US
Practice Address - Phone:978-930-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-21
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2336267163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse