Provider Demographics
NPI:1710234513
Name:BRACHVOGEL, CASEY (CRNA, PMHNP)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:BRACHVOGEL
Suffix:
Gender:M
Credentials:CRNA, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 N BROADWAY UNIT G
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2171
Mailing Address - Country:US
Mailing Address - Phone:857-256-1487
Mailing Address - Fax:
Practice Address - Street 1:288 N BROADWAY UNIT G
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2171
Practice Address - Country:US
Practice Address - Phone:857-256-1487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH07948323367500000X
MA90198367500000X
NH079483-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered