Provider Demographics
NPI:1427381128
Name:CASAMATTA, DALE A (RN)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:A
Last Name:CASAMATTA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HIGH POINT LN
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-6973
Mailing Address - Country:US
Mailing Address - Phone:440-942-3128
Mailing Address - Fax:
Practice Address - Street 1:16 HIGH POINT LN
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-6973
Practice Address - Country:US
Practice Address - Phone:440-942-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-12
Last Update Date:2009-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN283139163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse