Basic Information
| Provider Information | |||||||||
| NPI: | 1043784861 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUSHING | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | CPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4309 S LOCUST DR APT 3 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571057151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072067136 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2501 W 22ND ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053363230 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2019 | ||||||||
| LastUpdateDate: | 01/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246RP1900X | MN | Y | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Phlebotomy |
No ID Information.