Provider Demographics
NPI:1881162774
Name:ROCHA, CAITLIN MAUREEN (NP-C, MSN, BSN)
Entity type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:MAUREEN
Last Name:ROCHA
Suffix:
Gender:F
Credentials:NP-C, MSN, BSN
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:MAUREEN
Other - Last Name:MACKINNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C; MSN, BSN
Mailing Address - Street 1:4301 W 95TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2698
Mailing Address - Country:US
Mailing Address - Phone:708-425-5500
Mailing Address - Fax:708-425-0771
Practice Address - Street 1:4301 W 95TH ST STE 1
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2698
Practice Address - Country:US
Practice Address - Phone:708-425-5500
Practice Address - Fax:708-425-0771
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily