Healthcare Provider Details

I. General information

NPI: 1649296708
Provider Name (Legal Business Name): CASSANDRA LYNN SANTUS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17512 COTTON BAKER CT
CORNELIUS NC
28031-5785
US

IV. Provider business mailing address

17512 COTTON BAKER CT
CORNELIUS NC
28031-5785
US

V. Phone/Fax

Practice location:
  • Phone: 724-591-6873
  • Fax:
Mailing address:
  • Phone: 724-591-6873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number157178
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: