Provider Demographics
NPI:1750642377
Name:CASALLO, CORAZON B (RN)
Entity Type:Individual
Prefix:MRS
First Name:CORAZON
Middle Name:B
Last Name:CASALLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 S HEATHER MEADOWS LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3864
Mailing Address - Country:US
Mailing Address - Phone:832-455-5153
Mailing Address - Fax:
Practice Address - Street 1:1756 S HEATHER MEADOWS LOOP
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3864
Practice Address - Country:US
Practice Address - Phone:832-455-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100966372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion