Healthcare Provider Details

I. General information

NPI: 1629829247
Provider Name (Legal Business Name): CASANDRA HARMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASANDRA KOPISCHKE

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-3366
  • Fax:
Mailing address:
  • Phone: 602-933-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2485593
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number337578
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number332198
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: