MEDICARE: ELSON CASIANO NURSE (LPN)

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	019616	PR

General Provider Information

NPI Number	:	1306066691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELSON CASIANO NURSE (LPN)

Provider Business Mailing Address
First Line	:	71 CALLE CORAL
Second Line	:	REPARTO PUEBLO NUEVO
City	:	SAN GERMAN
State	:	PR
Zip	:	00683-4306
Country	:	US
Telephone Number	:	787-892-4093
Fax Number	:	787-833-1371

Provider Business Practice Location Address
First Line	:	CENTRO SALUD MENTAL DE MAYAGUEZ
Second Line	:	410 AVE HOSTOS SUITE 7
City	:	MAYAGUEZ
State	:	PR
Zip	:	00682-1522
Country	:	US
Telephone Number	:	787-833-0663
Fax Number	:	787-833-1371

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	07/08/2007

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