Provider Demographics
NPI:1871192500
Name:WARREN, CAITIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:CAITIE
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17457 CAFFEE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:DAHLGREN
Mailing Address - State:VA
Mailing Address - Zip Code:22448-5120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17457 CAFFEE RD STE 204
Practice Address - Street 2:
Practice Address - City:DAHLGREN
Practice Address - State:VA
Practice Address - Zip Code:22448-5120
Practice Address - Country:US
Practice Address - Phone:760-725-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110008120363A00000X, 171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant