Provider Demographics
NPI:1770363210
Name:CASIMIR, NIKEL AUSTELLY (PA)
Entity type:Individual
Prefix:
First Name:NIKEL
Middle Name:AUSTELLY
Last Name:CASIMIR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:133 PLEASANT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-2700
Mailing Address - Country:US
Mailing Address - Phone:978-767-7612
Mailing Address - Fax:
Practice Address - Street 1:4374 EAST BUTTE AVENUE
Practice Address - Street 2:EYMAN/ MEADOWNS UNIT
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132
Practice Address - Country:US
Practice Address - Phone:978-767-7612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9972363A00000X, 207Q00000X, 2083P0901X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical