Provider Demographics
NPI:1649541012
Name:WHITTEN, CATHY M (LVN/DSD)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:M
Last Name:WHITTEN
Suffix:
Gender:F
Credentials:LVN/DSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 N. ARTHUR AVE.
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:92705-0626
Mailing Address - Country:US
Mailing Address - Phone:559-477-5164
Mailing Address - Fax:
Practice Address - Street 1:4645 N ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-0626
Practice Address - Country:US
Practice Address - Phone:559-477-5164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN199103164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse