Caitlyn Clare Wagenbach, PA-C
Physician Assistant in Peoria Heights, IL. Individual provider (NPI-1).
NPI number1346856846
StatusActive
Last updated in NPPESOct 22, 2024
Details
- NPI
- 1346856846
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Caitlyn Clare Wagenbach
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Sep 20, 2020
- Certification date
- Oct 22, 2024
- Last updated
- Oct 22, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | – | – | Yes |
Other names
- Caitlyn Clare Honan (Former Name)
Practice location
4616 N Prospect RdPeoria Heights, IL 61616-6460
Phone 217-528-7541
Mailing address
Po Box 19248Springfield, IL 62794-9248
Phone 217-528-7541
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