Provider Demographics
NPI:1326632480
Name:WALCHONSKI, CAITLIN F (APRN)
Entity type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:F
Last Name:WALCHONSKI
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:ESTEE
Other - Last Name:FUHRMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:1805 HUCKLEBERRY AVE
Practice Address - Street 2:
Practice Address - City:OMRO
Practice Address - State:WI
Practice Address - Zip Code:54963-1851
Practice Address - Country:US
Practice Address - Phone:920-685-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11295-33363LF0000X
MN7833363LF0000X
WI11295363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100194218Medicaid