MEDICARE: CAITLIN J WILSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1131937	IA

General Provider Information

NPI Number	:	1023463890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN J WILSON PA-C

Provider Business Mailing Address
First Line	:	865 LINCOLN RD STE L10
Second Line	:
City	:	BETTENDORF
State	:	IA
Zip	:	52722-4159
Country	:	US
Telephone Number	:	563-355-9200
Fax Number	:	563-355-3419

Provider Business Practice Location Address
First Line	:	1230 E RUSHOLME ST
Second Line	:	SUITE 150
City	:	DAVENPORT
State	:	IA
Zip	:	52803-2452
Country	:	US
Telephone Number	:	563-421-3990
Fax Number	:	563-421-3999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2016
Last Update Date	:	04/29/2016

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