Healthcare Provider Details

I. General information

NPI: 1518964907
Provider Name (Legal Business Name): CATHERINE TERESA CARUSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 PARK VISTA TERRACE
ALLENTOWN PA
18104
US

IV. Provider business mailing address

1641 RED PINE LANE
EFFORT PA
18330-9103
US

V. Phone/Fax

Practice location:
  • Phone: 610-703-7244
  • Fax:
Mailing address:
  • Phone: 610-554-6104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberUP006315H
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: