Provider Demographics
NPI: | 1942293626 |
---|---|
Name: | CASLER, LISA A (NP) |
Entity Type: | Individual |
Prefix: | MS |
First Name: | LISA |
Middle Name: | A |
Last Name: | CASLER |
Suffix: | |
Gender: | F |
Credentials: | NP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 32 HARTFORD TER |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW HARTFORD |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 13413-2308 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 607-434-8409 |
Mailing Address - Fax: | 315-738-4450 |
Practice Address - Street 1: | 1400 NOYES ST |
Practice Address - Street 2: | |
Practice Address - City: | UTICA |
Practice Address - State: | NY |
Practice Address - Zip Code: | 13502-3854 |
Practice Address - Country: | US |
Practice Address - Phone: | 315-738-3800 |
Practice Address - Fax: | 315-738-4450 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-08-26 |
Last Update Date: | 2023-04-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 510913 | 163WP0808X |
NY | 400610 | 363LP0808X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health |
No | 163WP0808X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | DD0322 | Medicare PIN | |
NY | P25671 | Medicare UPIN |