Provider Demographics
NPI:1295300275
Name:CARUSO, MANDY EDWARDS (CRNP)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:EDWARDS
Last Name:CARUSO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4812 COMMERCIAL DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35816-2206
Mailing Address - Country:US
Mailing Address - Phone:256-518-9998
Mailing Address - Fax:
Practice Address - Street 1:4812 COMMERCIAL DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-2206
Practice Address - Country:US
Practice Address - Phone:256-518-9998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-1443838363LF0000X
AL1-143838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily