| Doctor Name: | CAITLIN PHELAN |
| NPI Number: | 1548526361 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 209009460 |
| Business Practice Address: | 320 E. Hwy 50 Ofallon, IL - 62269 |
| Business Phone Number: | 6186243368 |
| Business Fax Number: | |
| Mailing Address: | 44 South Cherry Hills, EDWARDSVILLE |
| State: | IL |
| Postal Code: | 62025 |
| Phone Number: | 6184067738 |
| Fax Number: | |
| NPI Enumeration Date: | 04/05/2012 |
| NPI Last Update Date: | 08/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209009460 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |