Provider Demographics
NPI:1275921330
Name:KACZOR, CAITLYN (CRNP)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:KACZOR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SOUTH FRONT STREET
Mailing Address - Street 2:6TH FLOOR BMA
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1619
Mailing Address - Country:US
Mailing Address - Phone:717-988-9370
Mailing Address - Fax:717-703-0154
Practice Address - Street 1:205 SOUTH FRONT STREET
Practice Address - Street 2:6TH FLOOR BMA
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1619
Practice Address - Country:US
Practice Address - Phone:717-988-9370
Practice Address - Fax:717-703-0154
Is Sole Proprietor?:No
Enumeration Date:2014-12-24
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014525363L00000X, 363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health