Basic Information
| Provider Information | |||||||||
| NPI: | 1184994881 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DALE | ||||||||
| FirstName: | CATHY | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 PIEDMONT AVE | ||||||||
| Address2: | SUITE 5200 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452194231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134758400 | ||||||||
| FaxNumber: | 5134758228 | ||||||||
| Practice Location | |||||||||
| Address1: | 7700 UNIVERSITY CT | ||||||||
| Address2: | 3900 | ||||||||
| City: | WEST CHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450696542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134758400 | ||||||||
| FaxNumber: | 5134758228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2012 | ||||||||
| LastUpdateDate: | 01/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207KI0005X | PN-145108 | OH | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology | Clinical & Laboratory Immunology |
ID Information
| ID | Type | State | Issuer | Description | PN-145108 | 05 | OH | MEDICAID |