Provider Demographics
NPI:1790478188
Name:CSA MEDICAL LLC
Entity Type:Organization
Organization Name:CSA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:SHERISE
Authorized Official - Last Name:ANANE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-281-3407
Mailing Address - Street 1:924 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2629
Mailing Address - Country:US
Mailing Address - Phone:860-281-3407
Mailing Address - Fax:
Practice Address - Street 1:924 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2629
Practice Address - Country:US
Practice Address - Phone:860-281-3407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty