MEDICARE: CAITLIN GREENFIELD FNP-BC

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	163WG0000X	General Practice Registered Nurse	041.446555	IL
2	363L00000X	Nurse Practitioner	209.026074	IL

General Provider Information

NPI Number	:	1184371668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN GREENFIELD FNP-BC

Provider Business Mailing Address
First Line	:	12850 S ASHLAND AVE
Second Line	:
City	:	CALUMET PARK
State	:	IL
Zip	:	60827-6308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12850 S ASHLAND AVE
Second Line	:
City	:	CALUMET PARK
State	:	IL
Zip	:	60827-6308
Country	:	US
Telephone Number	:	708-972-7958
Fax Number	:

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

Provider Enumeration Date	:	03/04/2022
Last Update Date	:	02/15/2023

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