Healthcare Provider Details

I. General information

NPI: 1306762075
Provider Name (Legal Business Name): CASSANDRA JANE DEWULF FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 COUNTY ROAD 6 E
ELKHART IN
46514-7673
US

IV. Provider business mailing address

1514 GAULEY RIVER DR
MISHAWAKA IN
46544-6868
US

V. Phone/Fax

Practice location:
  • Phone: 574-264-3561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number28215732A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: