Provider Demographics
NPI:1508513714
Name:BOYAK, CAITLIN (DNP, AGACNP-BC, RN)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:
Last Name:BOYAK
Suffix:
Gender:F
Credentials:DNP, AGACNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 W DIVERSEY PKWY UNIT A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1114
Mailing Address - Country:US
Mailing Address - Phone:248-982-8113
Mailing Address - Fax:
Practice Address - Street 1:1525 W HARRISON ST STE 1159
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3105
Practice Address - Country:US
Practice Address - Phone:312-947-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILPENDING363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology