Healthcare Provider Details

I. General information

NPI: 1184227233
Provider Name (Legal Business Name): CASSANDRA ANTOINE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/21/2020
Certification Date: 11/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 NEPONSET AVE
BOSTON MA
02122-3134
US

IV. Provider business mailing address

398 NEPONSET AVE
BOSTON MA
02122-3134
US

V. Phone/Fax

Practice location:
  • Phone: 617-282-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN2339558
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: