Provider Demographics
NPI:1083339162
Name:LOFSTEAD, CALEIGH ANNE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:CALEIGH
Middle Name:ANNE
Last Name:LOFSTEAD
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 W HUBBARD ST APT 1602
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4612
Mailing Address - Country:US
Mailing Address - Phone:360-904-2882
Mailing Address - Fax:
Practice Address - Street 1:3229 W 47TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-3011
Practice Address - Country:US
Practice Address - Phone:773-254-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383490363LP0200X
IL030248363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics