Provider Demographics
NPI:1003200791
Name:AVERILL, CAITLIN MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MARIE
Last Name:AVERILL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:MARIE
Other - Last Name:AVERILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:114 BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1229
Mailing Address - Country:US
Mailing Address - Phone:410-833-2772
Mailing Address - Fax:410-526-4897
Practice Address - Street 1:114 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1229
Practice Address - Country:US
Practice Address - Phone:410-833-2772
Practice Address - Fax:410-526-4897
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR196399363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care