Provider Demographics
NPI:1194320234
Name:MCHALE, CAITLYN S (LPN)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:S
Last Name:MCHALE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 S MAIN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-3157
Mailing Address - Country:US
Mailing Address - Phone:315-719-8400
Mailing Address - Fax:
Practice Address - Street 1:447 S MAIN ST APT 2
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-3157
Practice Address - Country:US
Practice Address - Phone:315-719-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325308164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse