Healthcare Provider Details

I. General information

NPI: 1245760461
Provider Name (Legal Business Name): CASSANDRA MAE ULLYOTT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 08/26/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 1ST AVE
CANDO ND
58324-7500
US

IV. Provider business mailing address

7448 U.S. 281
CANDO ND
58324
US

V. Phone/Fax

Practice location:
  • Phone: 701-968-4411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06170530
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: