Provider Demographics
NPI:1275012486
Name:CASAS, PRISCILLA (RN)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:CASAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 UPTOWN BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10800 DENNIS CHAVEZ BLVD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-5498
Practice Address - Country:US
Practice Address - Phone:505-243-1458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-84090163WU0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WU0100XNursing Service ProvidersRegistered NurseUrologyGroup - Single Specialty