Healthcare Provider Details

I. General information

NPI: 1912293416
Provider Name (Legal Business Name): NANCY ALICE CASAVIS RN., ME.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 EDGEMERE AVE
GREENWOOD LAKE NY
10925-2400
US

IV. Provider business mailing address

108 EDGEMERE AVE
GREENWOOD LAKE NY
10925-2400
US

V. Phone/Fax

Practice location:
  • Phone: 845-595-1223
  • Fax:
Mailing address:
  • Phone: 845-595-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number471934
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9256669
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: