Healthcare Provider Details

I. General information

NPI: 1851984942
Provider Name (Legal Business Name): CAITLYN RAE WAUGH LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLYN RAE BOWLING

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8323 STATE ROUTE 7 N
CHESHIRE OH
45620-9001
US

IV. Provider business mailing address

PO BOX 188
CHILLICOTHEE OH
45601-0188
US

V. Phone/Fax

Practice location:
  • Phone: 740-992-2192
  • Fax: 740-992-4018
Mailing address:
  • Phone: 740-773-4366
  • Fax: 740-773-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.177924.MEDS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: