Provider Demographics
NPI:1588384499
Name:FREEZE, CAITLIN MICHELLE
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MICHELLE
Last Name:FREEZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:MICHELLE
Other - Last Name:SCHULTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 STARKE LN
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-1864
Mailing Address - Country:US
Mailing Address - Phone:609-670-7321
Mailing Address - Fax:
Practice Address - Street 1:1020 SANSOM STREET
Practice Address - Street 2:THOMPSON BUILDING STE 239
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-955-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN657440163W00000X
PASP026650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN657440OtherPENNSYLVANIA STATE BOARD OF NURSING - REGISTERED NURSE
PASP026650OtherPENNSYLVANIA STATE BOARD OF NURSING - CERTIFIED REGISTERED NURSE PRACTITIONER