Healthcare Provider Details

I. General information

NPI: 1952934630
Provider Name (Legal Business Name): BRIANNA CASAMASSIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA MILIDEO

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BOWMAN DR
VOORHEES NJ
08043-9612
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-247-2645
  • Fax: 856-247-2905
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number26NR18426000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number26NJ01023100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: