Provider Demographics
NPI:1730317645
Name:STOWE, CAITLYN WENZEL (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CAITLYN
Middle Name:WENZEL
Last Name:STOWE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CAITLYN
Other - Middle Name:WENZEL
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-7190
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:1000 STONEWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8386
Practice Address - Country:US
Practice Address - Phone:724-778-3020
Practice Address - Fax:724-778-3024
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053895363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant