Provider Demographics
NPI:1508218140
Name:BRAITHWAITE, CAITLIN MARIE POLGREEN (APRN, CNP)
Entity Type:Individual
Prefix:MS
First Name:CAITLIN
Middle Name:MARIE POLGREEN
Last Name:BRAITHWAITE
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:MS
Other - First Name:CAITLIN
Other - Middle Name:MARIE
Other - Last Name:POLGREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-8364
Mailing Address - Fax:
Practice Address - Street 1:420 E 1ST ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1901
Practice Address - Country:US
Practice Address - Phone:218-786-8364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9830933-4405363LF0000X
MN7398363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily