Provider Demographics
NPI:1396428637
Name:WENTZ, CAITLIN HICKS (RN)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:HICKS
Last Name:WENTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:HICKS
Other - Last Name:BARTLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:91112 N SPORES ST
Mailing Address - Street 2:
Mailing Address - City:COBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97408-9527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91112 N SPORES ST
Practice Address - Street 2:
Practice Address - City:COBURG
Practice Address - State:OR
Practice Address - Zip Code:97408-9527
Practice Address - Country:US
Practice Address - Phone:503-858-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201142632RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse