Healthcare Provider Details

I. General information

NPI: 1215798855
Provider Name (Legal Business Name): CAITLIN VANDERMEEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 E ALLUVIAL AVE APT 214
FRESNO CA
93720-0490
US

IV. Provider business mailing address

2350 E ALLUVIAL AVE APT 214
FRESNO CA
93720-0490
US

V. Phone/Fax

Practice location:
  • Phone: 617-921-7270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number59220
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: