Provider Demographics
NPI:1780815910
Name:BRUSH, CATHERINE JOHANNA (LPN)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:JOHANNA
Last Name:BRUSH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 GOLD ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1511
Mailing Address - Country:US
Mailing Address - Phone:607-334-6908
Mailing Address - Fax:
Practice Address - Street 1:37 GOLD ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1511
Practice Address - Country:US
Practice Address - Phone:607-334-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204502-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse