Healthcare Provider Details

I. General information

NPI: 1134834989
Provider Name (Legal Business Name): CAITLYN ALLEY WITWICKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 06/22/2024
Certification Date: 06/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12B PUNKINTOWN RD
ELIOT ME
03903-1214
US

IV. Provider business mailing address

12B PUNKINTOWN RD
ELIOT ME
03903-1214
US

V. Phone/Fax

Practice location:
  • Phone: 207-319-0804
  • Fax:
Mailing address:
  • Phone: 207-319-0804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA96353
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN87930
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: