MEDICARE: SAHSA CASBORN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	214488	LA

General Provider Information

NPI Number	:	1598589798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAHSA CASBORN RN

Provider Business Mailing Address
First Line	:	1423 W CAUSEWAY APPROACH
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3045
Country	:	US
Telephone Number	:	504-250-0624
Fax Number	:

Provider Business Practice Location Address
First Line	:	1423 W CAUSEWAY APPROACH
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3045
Country	:	US
Telephone Number	:	504-250-0624
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2024
Last Update Date	:	11/13/2024

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