Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 019023172 | IL |
NPI | 1013098045 |
---|---|
Provider Name | Dr. Catherine E. Cavanaugh |
First Address | Forsyth, IL 62535-9741 |
Second Address | Forsyth, IL 62535-9764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 02/12/2020 |