Individual
MRS. CAITLYN CLARE WAGENBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4616 N PROSPECT RD, PEORIA HEIGHTS, IL 61616-6460
(217) 528-7541
Mailing address
PO BOX 19248, SPRINGFIELD, IL 62794-9248
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/20/2020
Last updated
10/22/2024
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