Healthcare Provider Details

I. General information

NPI: 1427598739
Provider Name (Legal Business Name): CASSANDRA JUNE HOTALING-HAHN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LIVEWELL DR
KENNEBUNK ME
04043-6762
US

IV. Provider business mailing address

29 WOODHAVEN DR
KENNEBUNK ME
04043-6559
US

V. Phone/Fax

Practice location:
  • Phone: 207-467-8988
  • Fax:
Mailing address:
  • Phone: 802-236-1841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: