Healthcare Provider Details

I. General information

NPI: 1447147855
Provider Name (Legal Business Name): CASSANDRA JEANNE RASILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 W SHANNON WAY
COOLIDGE AZ
85128-6715
US

IV. Provider business mailing address

1434 W SHANNON WAY
COOLIDGE AZ
85128-6715
US

V. Phone/Fax

Practice location:
  • Phone: 480-717-1477
  • Fax:
Mailing address:
  • Phone: 480-717-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number240181
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number240181
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: