Provider Demographics
NPI:1619515384
Name:CAUFIELD, EMILY (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:CAUFIELD
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 PIERCE BLVD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2588
Mailing Address - Country:US
Mailing Address - Phone:618-222-9244
Mailing Address - Fax:
Practice Address - Street 1:604 PIERCE BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2588
Practice Address - Country:US
Practice Address - Phone:618-222-9244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020428208000000X
MO2019012551208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics