Provider Demographics
NPI:1700174414
Name:DAHLQUIST, CASEY ELIZABETH (LPN)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:ELIZABETH
Last Name:DAHLQUIST
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:CASEY
Other - Middle Name:ELIZABETH
Other - Last Name:LANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:450 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4455
Mailing Address - Country:US
Mailing Address - Phone:781-329-0909
Mailing Address - Fax:
Practice Address - Street 1:15 BEACON AVE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-2018
Practice Address - Country:US
Practice Address - Phone:781-769-8674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN87928164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse