Healthcare Provider Details

I. General information

NPI: 1902244239
Provider Name (Legal Business Name): TAMMY SUE CASSEL CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2013
Last Update Date: 06/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 EVERGREEN RD
SPRINGFIELD MI
49037-7417
US

IV. Provider business mailing address

31 MOSHER AVE
BATTLE CREEK MI
49037-1407
US

V. Phone/Fax

Practice location:
  • Phone: 269-969-6110
  • Fax:
Mailing address:
  • Phone: 269-579-0588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number230015692121111
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: