Healthcare Provider Details

I. General information

NPI: 1235866377
Provider Name (Legal Business Name): CAITLYN STOEWER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S MERCER AVE STE GF7
BLOOMINGTON IL
61701-7107
US

IV. Provider business mailing address

2601 INTERLOCKEN DR
BLOOMINGTON IL
61704-8313
US

V. Phone/Fax

Practice location:
  • Phone: 309-660-8442
  • Fax:
Mailing address:
  • Phone: 309-532-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: