Healthcare Provider Details

I. General information

NPI: 1538522941
Provider Name (Legal Business Name): CASEY VIZENOR CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2016
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E EVESHAM RD STE A
VOORHEES NJ
08043-9590
US

IV. Provider business mailing address

PO BOX 536
VOORHEES NJ
08043-0536
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-3323
  • Fax: 856-424-4994
Mailing address:
  • Phone: 856-669-6024
  • Fax: 856-651-0794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR18297700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: