Healthcare Provider Details

I. General information

NPI: 1386757151
Provider Name (Legal Business Name): FE VIRGINIA C DEL CASAL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 827 BOX 1000
FPO AE
09617
US

IV. Provider business mailing address

PSC 827 BOX 63
FPO AE
09617
US

V. Phone/Fax

Practice location:
  • Phone: 390818116472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number586629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: