Healthcare Provider Details

I. General information

NPI: 1407765761
Provider Name (Legal Business Name): GEORGIA MAE CASON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 30TH ST
DES MOINES IA
50310-5753
US

IV. Provider business mailing address

5525 SE 24TH ST
DES MOINES IA
50320-2735
US

V. Phone/Fax

Practice location:
  • Phone: 515-699-5771
  • Fax: 515-699-5727
Mailing address:
  • Phone: 515-699-5771
  • Fax: 515-699-5727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number111101
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: