Healthcare Provider Details

I. General information

NPI: 1710234513
Provider Name (Legal Business Name): CASEY BRACHVOGEL CRNA, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 N BROADWAY UNIT G
SALEM NH
03079-2171
US

IV. Provider business mailing address

288 N BROADWAY UNIT G
SALEM NH
03079-2171
US

V. Phone/Fax

Practice location:
  • Phone: 857-256-1487
  • Fax:
Mailing address:
  • Phone: 857-256-1487
  • Fax: 844-286-3402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number90198
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number079483-23
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number07948323
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: