Provider Demographics
NPI:1134834989
Name:WITWICKI, CAITLYN ALLEY (RN)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:ALLEY
Last Name:WITWICKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12B PUNKINTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-1214
Mailing Address - Country:US
Mailing Address - Phone:207-319-0804
Mailing Address - Fax:
Practice Address - Street 1:12B PUNKINTOWN RD
Practice Address - Street 2:
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-1214
Practice Address - Country:US
Practice Address - Phone:207-319-0804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN87930163W00000X
MECNA96353376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide