Healthcare Provider Details

I. General information

NPI: 1043174659
Provider Name (Legal Business Name): BRANDON CASANOVA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1090
BUIES CREEK NC
27506-1090
US

IV. Provider business mailing address

PO BOX 1090
BUIES CREEK NC
27506-1090
US

V. Phone/Fax

Practice location:
  • Phone: 910-495-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: