Provider Demographics
NPI:1477350148
Name:MROZ, CAITLIN ROSE (LPN)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ROSE
Last Name:MROZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:787 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUSQUEHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18847-1221
Mailing Address - Country:US
Mailing Address - Phone:607-201-3605
Mailing Address - Fax:607-201-3605
Practice Address - Street 1:787 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SUSQUEHANNA
Practice Address - State:PA
Practice Address - Zip Code:18847-1221
Practice Address - Country:US
Practice Address - Phone:607-201-3605
Practice Address - Fax:607-201-3605
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342235164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse