Provider Demographics
NPI:1790112274
Name:WELLER, CAITLIN ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ANNE
Last Name:WELLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 PFINGSTEN RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1301
Mailing Address - Country:US
Mailing Address - Phone:847-657-5632
Mailing Address - Fax:847-657-5993
Practice Address - Street 1:880 W CENTRAL RD STE 5000
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2355
Practice Address - Country:US
Practice Address - Phone:847-618-3800
Practice Address - Fax:847-618-3809
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.004830363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085004830OtherSTATE LICENSE