Provider Demographics
NPI:1003608407
Name:WING, CAILTLIN
Entity type:Individual
Prefix:
First Name:CAILTLIN
Middle Name:
Last Name:WING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:VANDUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:174 FULLER AVE
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-1353
Mailing Address - Country:US
Mailing Address - Phone:607-385-5693
Mailing Address - Fax:
Practice Address - Street 1:7309 SENECA RD N
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-9691
Practice Address - Country:US
Practice Address - Phone:607-282-5200
Practice Address - Fax:585-335-5061
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326576-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161039939Medicaid
NY161039939OtherALL OTHER INSURANCES