Provider Demographics
NPI:1578546628
Name:CASWELL, DEBORAH RUDENE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:RUDENE
Last Name:CASWELL
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Gender:F
Credentials:NP-C
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Mailing Address - Street 1:465 SAINT MICHAELS DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7670
Mailing Address - Country:US
Mailing Address - Phone:505-946-3180
Mailing Address - Fax:505-946-3181
Practice Address - Street 1:465 SAINT MICHAELS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7670
Practice Address - Country:US
Practice Address - Phone:505-946-3180
Practice Address - Fax:505-946-3181
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANP89032086S0129X
NMCNP 01770363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN323413Medicaid
CAS54019Medicare UPIN
CARN323413Medicaid