Provider Demographics
NPI:1740454495
Name:CASWELL, CARRIE L (PRIVATE DUTY LPN)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:L
Last Name:CASWELL
Suffix:
Gender:F
Credentials:PRIVATE DUTY LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3488 HUMPHREY RD
Mailing Address - Street 2:
Mailing Address - City:CATO
Mailing Address - State:NY
Mailing Address - Zip Code:13033
Mailing Address - Country:US
Mailing Address - Phone:315-678-2057
Mailing Address - Fax:
Practice Address - Street 1:3488 HUMPHREY RD
Practice Address - Street 2:
Practice Address - City:CATO
Practice Address - State:NY
Practice Address - Zip Code:13033-3134
Practice Address - Country:US
Practice Address - Phone:315-678-2057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2694961164W00000X
NY02292693164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02292693Medicaid