Provider Demographics
NPI:1053028860
Name:CAVANAUGH, CARLEIGH RAEANNA
Entity type:Individual
Prefix:
First Name:CARLEIGH
Middle Name:RAEANNA
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 CLAUSEL ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-2204
Mailing Address - Country:US
Mailing Address - Phone:198-537-7595
Mailing Address - Fax:
Practice Address - Street 1:1620 CLAUSEL ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-2204
Practice Address - Country:US
Practice Address - Phone:985-377-5956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program