Healthcare Provider Details

I. General information

NPI: 1801705884
Provider Name (Legal Business Name): CASANDRA D BERCAW RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST BLVD
ELKHART IN
46514-2483
US

IV. Provider business mailing address

946 GREENFIELD RD
BRONSON MI
49028-9778
US

V. Phone/Fax

Practice location:
  • Phone: 517-617-2960
  • Fax:
Mailing address:
  • Phone: 517-617-2960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28296919A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: