Provider Demographics
NPI:1427027960
Name:CASIMIR, VALENTINA KETLIE (CRNA)
Entity type:Individual
Prefix:MS
First Name:VALENTINA
Middle Name:KETLIE
Last Name:CASIMIR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:VALENTINA
Other - Middle Name:KETLIE
Other - Last Name:APOLLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3155 N POINT PKWY
Mailing Address - Street 2:ATTN CREDENTIALING DEPT, BUILDING F, SUITE 100
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-645-9181
Mailing Address - Fax:770-645-8455
Practice Address - Street 1:780 CANTON ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7259
Practice Address - Country:US
Practice Address - Phone:678-574-0943
Practice Address - Fax:678-574-0943
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN132859367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA631542956AMedicaid
GA631542956AMedicaid
GA43BBCMDMedicare PIN