Provider Demographics
NPI:1609204684
Name:HERBENER, CAITLIN E (PA-C)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:E
Last Name:HERBENER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:E
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2550 MOSSIDE BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3540
Mailing Address - Country:US
Mailing Address - Phone:412-373-6666
Mailing Address - Fax:
Practice Address - Street 1:2550 MOSSIDE BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3540
Practice Address - Country:US
Practice Address - Phone:412-373-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056501363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA321255QJDMedicare PIN