MEDICARE: MRS. CAITLIN MEREDITH WETZEL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-06516	NC
2	363A00000X	Physician Assistant	25MP00405600	NJ

General Provider Information

NPI Number	:	1649727306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAITLIN MEREDITH WETZEL PA-C

Provider Business Mailing Address
First Line	:	935 SHOTWELL RD
Second Line	:	SUITE 108
City	:	CLAYTON
State	:	NC
Zip	:	27520-5597
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3050 DURALEIGH RD STE 111
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-5451
Country	:	US
Telephone Number	:	984-215-6990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2016
Last Update Date	:	08/24/2021

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