Provider Demographics
NPI:1790140580
Name:ENGELS-ARTEAGA, CAITLIN J
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:J
Last Name:ENGELS-ARTEAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:J
Other - Last Name:ENGELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1405 E 12TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-9010
Mailing Address - Country:US
Mailing Address - Phone:815-538-7200
Mailing Address - Fax:815-539-1444
Practice Address - Street 1:1405 E 12TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:MENDOTA
Practice Address - State:IL
Practice Address - Zip Code:61342-9010
Practice Address - Country:US
Practice Address - Phone:815-538-7200
Practice Address - Fax:815-539-1444
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005651363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical