Provider Demographics
NPI:1326418252
Name:CASELLA, MARY CHRISTINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CHRISTINE
Last Name:CASELLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CHRISTINE
Other - Last Name:BEMENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 WEST GIBSON STREET
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424
Mailing Address - Country:US
Mailing Address - Phone:585-396-3940
Mailing Address - Fax:585-396-3779
Practice Address - Street 1:90 WEST GIBSON STREET
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424
Practice Address - Country:US
Practice Address - Phone:585-396-3940
Practice Address - Fax:585-396-3779
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY484973-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool