Provider Demographics
NPI:1144243437
Name:CASEY, SIRI L (RD CDE)
Entity Type:Individual
Prefix:
First Name:SIRI
Middle Name:L
Last Name:CASEY
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:SIRI
Other - Middle Name:A
Other - Last Name:LINDEBORG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 27829
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125
Mailing Address - Country:US
Mailing Address - Phone:505-232-1920
Mailing Address - Fax:505-727-9276
Practice Address - Street 1:5150 JOURNAL CENTER BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5900
Practice Address - Country:US
Practice Address - Phone:505-262-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM727392133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1144243437Medicaid