Provider Demographics
NPI:1629454137
Name:WINKLER, CAITLIN EILEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:EILEEN
Last Name:WINKLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:EILEEN
Other - Last Name:MARSICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:22567 SUMMIT DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-7210
Mailing Address - Country:US
Mailing Address - Phone:315-779-6784
Mailing Address - Fax:
Practice Address - Street 1:22567 SUMMIT DR BLDG 3
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-7210
Practice Address - Country:US
Practice Address - Phone:315-779-6784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030708363A00000X
IL085005575363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical