Healthcare Provider Details

I. General information

NPI: 1366473902
Provider Name (Legal Business Name): MRS. CHRISTINE ANN CASEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8619 OBRIAN AVE NE
OTSEGO MN
55330-7336
US

IV. Provider business mailing address

8619 OBRIAN AVE NE
OTSEGO MN
55330-7336
US

V. Phone/Fax

Practice location:
  • Phone: 763-274-1779
  • Fax:
Mailing address:
  • Phone: 763-274-1779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1020159-2-WS
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: