Healthcare Provider Details

I. General information

NPI: 1023724796
Provider Name (Legal Business Name): CAITLYN MATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 OVERLOOK TER
MADISON WI
53705-2254
US

IV. Provider business mailing address

1612 KNOB RD
BURLINGTON WI
53105-8603
US

V. Phone/Fax

Practice location:
  • Phone: 608-280-2370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number1101845
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: