MEDICARE: ABIGAIL GRACE CASALNOVA CRNP

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	363LP0200X	Pediatric Nurse Practitioner	58053	WY
2	363LP0200X	Pediatric Nurse Practitioner	1679267	CO
3	363LP0200X	Pediatric Nurse Practitioner	SP026310	PA
4	363LP0200X	Pediatric Nurse Practitioner	86830	NM

General Provider Information

NPI Number	:	1700503257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL GRACE CASALNOVA CRNP

Provider Business Mailing Address
First Line	:	1550 PLATTE ST APT A475
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-6151
Country	:	US
Telephone Number	:	724-372-4875
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 N HIGH ST STE 300
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-5503
Country	:	US
Telephone Number	:	303-226-7230
Fax Number	:	866-401-9731

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

Provider Enumeration Date	:	10/25/2022
Last Update Date	:	01/08/2026

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