Healthcare Provider Details

I. General information

NPI: 1114491776
Provider Name (Legal Business Name): MARIE LOUISE CASSALIA CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE MICHAUD

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 OMEGA DR BLDG B-86
NEWARK DE
19713-2065
US

IV. Provider business mailing address

200 HYGEIA DR STE 2300
NEWARK DE
19713-2049
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-1929
  • Fax: 302-368-7943
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR148310
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberLV-0000124
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: