MEDICARE: CASSANDRA NAEGLE DICKINSON

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1922937531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA NAEGLE DICKINSON

Provider Business Mailing Address
First Line	:	4655 MAPLELAWN DR
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-4768
Country	:	US
Telephone Number	:	505-506-3710
Fax Number	:

Provider Business Practice Location Address
First Line	:	2990 N STATE HIGHWAY 7
Second Line	:
City	:	NORTH VERNON
State	:	IN
Zip	:	47265-7189
Country	:	US
Telephone Number	:	505-506-3710
Fax Number	:

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

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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