Provider Demographics
NPI:1396406922
Name:CHALLACOMBE, CASILYN MARIE (RN)
Entity Type:Individual
Prefix:
First Name:CASILYN
Middle Name:MARIE
Last Name:CHALLACOMBE
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 1:6709 ACADEMY RD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3363
Mailing Address - Country:US
Mailing Address - Phone:509-290-4554
Mailing Address - Fax:
Practice Address - Street 1:6709 ACADEMY RD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3363
Practice Address - Country:US
Practice Address - Phone:505-308-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM85396163W00000X
NM66599367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse