Provider Demographics
NPI:1750990271
Name:MCCARTHY, CAITLIN (MSN-FNP BC)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MSN-FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 N KINZIE AVE
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-1233
Mailing Address - Country:US
Mailing Address - Phone:815-933-2589
Mailing Address - Fax:
Practice Address - Street 1:990 N KINZIE AVE
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-1233
Practice Address - Country:US
Practice Address - Phone:815-933-2589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily