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General NPI Number Information
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NPI Number | 1770363210
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Entity Type | Individual
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Provider Name | NIKEL AUSTELLY CASIMIR PA
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Gender | Male
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Dates
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Enumeration Date | 10/03/2023
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 4374 EAST BUTTE AVENUE EYMAN/ MEADOWNS UNIT
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City | FLORENCE
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State | AZ
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Zip | 85132
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Country | US
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Telephone | 978-767-7612
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Fax |
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Provider Business Mailing Address
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Address Line | 133 PLEASANT ST APT 2
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-2700
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Country | US
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Telephone | 978-767-7612
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9972
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License Number State | AZ
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