MEDICARE: MS. DEBORAH RUDENE CASWELL NP-C

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	2086S0129X	Vascular Surgery Physician	NP8903	CA
2	363LA2200X	Adult Health Nurse Practitioner	CNP 01770	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578546628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH RUDENE CASWELL NP-C

Provider Business Mailing Address
First Line	:	465 SAINT MICHAELS DR
Second Line	:	SUITE 110
City	:	SANTA FE
State	:	NM
Zip	:	87505-7670
Country	:	US
Telephone Number	:	505-946-3180
Fax Number	:	505-946-3181

Provider Business Practice Location Address
First Line	:	465 SAINT MICHAELS DR
Second Line	:	SUITE 110
City	:	SANTA FE
State	:	NM
Zip	:	87505-7670
Country	:	US
Telephone Number	:	505-946-3180
Fax Number	:	505-946-3181

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	04/12/2011

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