Provider Demographics
NPI:1912293416
Name:CASAVIS, NANCY ALICE (RN, MED)
Entity Type:Individual
Prefix:MISS
First Name:NANCY
Middle Name:ALICE
Last Name:CASAVIS
Suffix:
Gender:F
Credentials:RN, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 EDGEMERE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10925-2400
Mailing Address - Country:US
Mailing Address - Phone:845-595-1223
Mailing Address - Fax:
Practice Address - Street 1:108 EDGEMERE AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD LAKE
Practice Address - State:NY
Practice Address - Zip Code:10925-2400
Practice Address - Country:US
Practice Address - Phone:845-595-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY471934163W00000X
FL9256669163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse