Healthcare Provider Details

I. General information

NPI: 1730488834
Provider Name (Legal Business Name): CAITLIN MARIE SHANNON YENTER DNP, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN MARIE SHANNON RN, BSN

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 08/01/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 STATE HIGHWAY 66
STEVENS POINT WI
54482-8410
US

IV. Provider business mailing address

4100 STATE HWY 66
MARSHFIELD WI
54449-5703
US

V. Phone/Fax

Practice location:
  • Phone: 715-847-3223
  • Fax:
Mailing address:
  • Phone: 715-343-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number174529-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number6548-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number6548-33
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6548
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: