Individual
CASEY L CAVANAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., R.D.
Contact information
Practice address
200 WEST HOSPITAL DRIVE, WHITERIVER, AZ 85941-0860
(928) 338-3647
(928) 338-3522
Mailing address
PO BOX 860, 200 WEST HOSPITAL DRIVE, WHITERIVER, AZ 85941-0860
(928) 338-3647
(928) 338-3522
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50
MEDICARE, MEDICAID, AND UPIN
AZ
Enumeration date
08/25/2009
Last updated
08/25/2009
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