Provider Demographics
NPI:1801813878
Name:CASADY, LAURA L (CFNP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:L
Last Name:CASADY
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 AMHERST DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1308
Mailing Address - Country:US
Mailing Address - Phone:505-417-0068
Mailing Address - Fax:
Practice Address - Street 1:401 AMHERST DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1308
Practice Address - Country:US
Practice Address - Phone:505-417-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR18256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR18256OtherLICENSE
NM000Q7422Medicaid
NM34671707Medicare PIN
NMS46373Medicare UPIN