Provider Demographics
NPI:1932085701
Name:CASAS, NELLY MICHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:NELLY
Middle Name:MICHELLE
Last Name:CASAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 MAJESTIC LN
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-4029
Mailing Address - Country:US
Mailing Address - Phone:630-605-9198
Mailing Address - Fax:
Practice Address - Street 1:3520 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:STONE PARK
Practice Address - State:IL
Practice Address - Zip Code:60165-1042
Practice Address - Country:US
Practice Address - Phone:708-356-6341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.011434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant