Provider Demographics
NPI:1457831547
Name:HUCKESTEIN, CASEY MARIE (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:MARIE
Last Name:HUCKESTEIN
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 LATONA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2921
Mailing Address - Country:US
Mailing Address - Phone:856-266-8476
Mailing Address - Fax:
Practice Address - Street 1:528 LIPPINCOTT DR
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4805
Practice Address - Country:US
Practice Address - Phone:856-983-3899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00849600363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics