Provider Demographics
NPI:1487221065
Name:HOUCK, CAITLIN MARIE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:MARIE
Last Name:HOUCK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:CAITLIN
Other - Middle Name:MARIE
Other - Last Name:GRAYNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4250 FRITCH DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-9412
Mailing Address - Country:US
Mailing Address - Phone:610-954-9040
Mailing Address - Fax:
Practice Address - Street 1:4250 FRITCH DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9412
Practice Address - Country:US
Practice Address - Phone:610-954-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022885363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner