MEDICARE: PATRICIA L. CAVANAGH L.P.N., L.I.S.A.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LPC#10043	AZ
2	101Y00000X	Counselor	LISAC#1435	AZ

General Provider Information

NPI Number	:	1235474875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA L. CAVANAGH L.P.N., L.I.S.A.C.

Provider Business Mailing Address
First Line	:	849 COVE PKWY
Second Line	:	SUITE A
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-4682
Country	:	US
Telephone Number	:	928-639-4389
Fax Number	:

Provider Business Practice Location Address
First Line	:	849 COVE PKWY
Second Line	:	SUITE A
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-4682
Country	:	US
Telephone Number	:	928-639-4389
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2012
Last Update Date	:	12/09/2012

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