Provider Demographics
NPI:1346856846
Name:WAGENBACH, CAITLYN CLARE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CAITLYN
Middle Name:CLARE
Last Name:WAGENBACH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:CLARE
Other - Last Name:HONAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:518 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2829
Mailing Address - Country:US
Mailing Address - Phone:563-333-5827
Mailing Address - Fax:
Practice Address - Street 1:518 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2829
Practice Address - Country:US
Practice Address - Phone:563-333-5886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-20
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant