Provider Demographics
NPI:1437120409
Name:CASEY, ANNETTE M (CNM,MSN)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:M
Last Name:CASEY
Suffix:
Gender:F
Credentials:CNM,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7170
Mailing Address - Country:US
Mailing Address - Phone:928-344-2000
Mailing Address - Fax:
Practice Address - Street 1:2911 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8000
Practice Address - Country:US
Practice Address - Phone:928-783-3050
Practice Address - Fax:928-783-7783
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN043917163W00000X
KY7451176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ850116Medicaid