Provider Demographics
NPI:1699396986
Name:CASKEY, MARK THOMAS (RN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:THOMAS
Last Name:CASKEY
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:W13306 STATE HIGHWAY 29
Mailing Address - Street 2:W13306 STATE HIGHWAY 29
Mailing Address - City:BOWLER
Mailing Address - State:WI
Mailing Address - Zip Code:54416-9513
Mailing Address - Country:US
Mailing Address - Phone:715-851-3156
Mailing Address - Fax:
Practice Address - Street 1:W13306 STATE HIGHWAY 29
Practice Address - Street 2:W13306 STATE HIGHWAY 29
Practice Address - City:BOWLER
Practice Address - State:WI
Practice Address - Zip Code:54416-9513
Practice Address - Country:US
Practice Address - Phone:715-851-3156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI67981-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty