Healthcare Provider Details

I. General information

NPI: 1306274568
Provider Name (Legal Business Name): CASSANDRA LEE ANDERSON CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2013
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL SE14
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-5550
  • Fax: 559-353-5587
Mailing address:
  • Phone: 559-353-5550
  • Fax: 559-353-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number731933
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number23418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: