Healthcare Provider Details

I. General information

NPI: 1992557987
Provider Name (Legal Business Name): MARISELA CASAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 08/17/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 HILLRISE DR
LAS CRUCES NM
88011-4703
US

IV. Provider business mailing address

3005 HILLRISE DR
LAS CRUCES NM
88011-4703
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-3980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1156538
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number78570
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: