Healthcare Provider Details

I. General information

NPI: 1154051316
Provider Name (Legal Business Name): CASSANDRA SUE JUNTUNEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CASSANDRA SUE ANDERSON

II. Dates (important events)

Enumeration Date: 06/12/2022
Last Update Date: 06/12/2022
Certification Date: 05/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 BEAM AVE
MAPLEWOOD MN
55109-1162
US

IV. Provider business mailing address

360 117TH AVE NW
COON RAPIDS MN
55448-2382
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-9500
  • Fax:
Mailing address:
  • Phone: 763-742-2876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9239
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: