Healthcare Provider Details

I. General information

NPI: 1164662920
Provider Name (Legal Business Name): CASSANDRA L KNIGHT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASSANDRA KNIGHT RN

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 E WILLIAMS FIELD RD
MESA AZ
85212-6033
US

IV. Provider business mailing address

6950 E WILLIAMS FIELD RD
MESA AZ
85212-6033
US

V. Phone/Fax

Practice location:
  • Phone: 602-222-6568
  • Fax: 602-222-6496
Mailing address:
  • Phone: 602-222-6568
  • Fax: 602-222-6496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN085141
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: