1164411732 NPI number — DR. CAROLYN MARIA CAUTILLI CRNP

Table of content: DR. CAROLYN MARIA CAUTILLI CRNP (NPI 1164411732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164411732 NPI number — DR. CAROLYN MARIA CAUTILLI CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAUTILLI
Provider First Name:
CAROLYN
Provider Middle Name:
MARIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164411732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 COTTONWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANGHORNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19047-8025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-579-7059
Provider Business Mailing Address Fax Number:
215-504-2587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 MARTIN GROSS DR
Provider Second Line Business Practice Location Address:
WOODS SERVICES
Provider Business Practice Location Address City Name:
LANGHORNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19047-1616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-750-4061
Provider Business Practice Location Address Fax Number:
215-750-4286
Provider Enumeration Date:
10/17/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  SP010966 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)