Provider Demographics
NPI:1538821541
Name:EHLERS, CAITLIN B (APRN, CNP)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:B
Last Name:EHLERS
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S HENNEPIN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-3077
Mailing Address - Country:US
Mailing Address - Phone:815-284-7733
Mailing Address - Fax:815-285-1487
Practice Address - Street 1:102 S HENNEPIN AVE STE 103
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-3077
Practice Address - Country:US
Practice Address - Phone:815-284-7733
Practice Address - Fax:815-285-1487
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily