Provider Demographics
NPI:1891205365
Name:MCQUARIE, CAITLIN EMILY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:EMILY
Last Name:MCQUARIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CAITLIN
Other - Middle Name:EMILY
Other - Last Name:BOOHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2712 E GERONIMO ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1212
Mailing Address - Country:US
Mailing Address - Phone:602-380-7672
Mailing Address - Fax:
Practice Address - Street 1:2712 E GERONIMO ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1212
Practice Address - Country:US
Practice Address - Phone:602-380-7672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6920363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6920OtherAZ MEDICAL BOARD