Provider Demographics
NPI:1174302467
Name:UNDERKOFFLER, CAITLIN FRIES (NP)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:FRIES
Last Name:UNDERKOFFLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 TOWNSHIP LINE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2249
Mailing Address - Country:US
Mailing Address - Phone:215-663-6067
Mailing Address - Fax:215-663-7089
Practice Address - Street 1:1200 W TABOR RD FL 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3019
Practice Address - Country:US
Practice Address - Phone:215-456-4600
Practice Address - Fax:215-456-9334
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP028257363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner