Provider Demographics
NPI:1508210352
Name:SURAF, CASEY (LPN)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:SURAF
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 W BECKER RD
Mailing Address - Street 2:
Mailing Address - City:GOWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14070-9727
Mailing Address - Country:US
Mailing Address - Phone:716-998-1153
Mailing Address - Fax:
Practice Address - Street 1:2660 W BECKER RD
Practice Address - Street 2:
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070-9727
Practice Address - Country:US
Practice Address - Phone:716-998-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294265164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse