Healthcare Provider Details

I. General information

NPI: 1063612190
Provider Name (Legal Business Name): CASSANDA HOWELL MAXWELL CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 HIGHWAY 80
HAUGHTON LA
71037-7425
US

IV. Provider business mailing address

1025 HIGHWAY 80
HAUGHTON LA
71037-7425
US

V. Phone/Fax

Practice location:
  • Phone: 318-949-0539
  • Fax: 318-949-0759
Mailing address:
  • Phone: 318-949-0539
  • Fax: 318-949-0759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP05255
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: