MEDICARE: FIROUZEH KASAIE CFNP

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	364SF0001X	Family Health Clinical Nurse Specialist	R33747	NM
2	363L00000X	Nurse Practitioner	CNP00697	NM

General Provider Information

NPI Number	:	1881833978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FIROUZEH KASAIE CFNP

Provider Business Mailing Address
First Line	:	PO BOX 26666
Second Line	:	PHS PROVIDER ENROLLMENT
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87125-6666
Country	:	US
Telephone Number	:	505-923-6770
Fax Number	:	505-923-5354

Provider Business Practice Location Address
First Line	:	2301 N MLK BLVD
Second Line	:
City	:	CLOVIS
State	:	NM
Zip	:	88101-9401
Country	:	US
Telephone Number	:	575-762-4455
Fax Number	:	575-762-8411

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

Provider Enumeration Date	:	02/12/2009
Last Update Date	:	05/10/2018

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