Healthcare Provider Details

I. General information

NPI: 1841127743
Provider Name (Legal Business Name): CAYTLYN SHUBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 N PROSPECT RD
PEORIA IL
61614-4311
US

IV. Provider business mailing address

3219 W CAPITOL DR
PEORIA IL
61614-2308
US

V. Phone/Fax

Practice location:
  • Phone: 309-308-5100
  • Fax:
Mailing address:
  • Phone: 309-357-8176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041527683
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: