MEDICARE: CASSIE KAUR DUNDON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	8857-33	WI
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1831685395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIE KAUR DUNDON

Provider Business Mailing Address
First Line	:	4525 N 133RD ST
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-1744
Country	:	US
Telephone Number	:	414-828-8866
Fax Number	:	361-200-5264

Provider Business Practice Location Address
First Line	:	4525 N 133RD ST
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-1744
Country	:	US
Telephone Number	:	414-828-8866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	03/02/2026

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