Healthcare Provider Details

I. General information

NPI: 1578207684
Provider Name (Legal Business Name): CAITLIN MARIE DUTRO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 OLENTANGY RIVER RD STE 1080
COLUMBUS OH
43214-3984
US

IV. Provider business mailing address

3555 OLENTANGY RIVER RD STE 1080
COLUMBUS OH
43214-3984
US

V. Phone/Fax

Practice location:
  • Phone: 614-268-8164
  • Fax:
Mailing address:
  • Phone: 567-230-2860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.0031758
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN.436405
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: