Healthcare Provider Details

I. General information

NPI: 1841973096
Provider Name (Legal Business Name): CASSANDRA ANN EDELMANN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 WATER ST
CHARLESTOWN IN
47111-1430
US

IV. Provider business mailing address

935 WATER ST
CHARLESTOWN IN
47111-1430
US

V. Phone/Fax

Practice location:
  • Phone: 812-256-3381
  • Fax: 812-256-6893
Mailing address:
  • Phone: 812-256-3381
  • Fax: 812-256-6893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71014195A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: