Provider Demographics
NPI:1215223011
Name:BURLESON, CAITLIN A (NP-C)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:A
Last Name:BURLESON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:A
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:WOT 12TH FL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-368-5532
Mailing Address - Fax:
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 320
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-368-3140
Practice Address - Fax:508-368-3196
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2268039363LF0000X
NH064334-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily