Healthcare Provider Details

I. General information

NPI: 1366306433
Provider Name (Legal Business Name): CASSANDRA MARIE DOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 13TH AVE E
WEST FARGO ND
58078-3376
US

IV. Provider business mailing address

3385 24TH ST S
MOORHEAD MN
56560-5408
US

V. Phone/Fax

Practice location:
  • Phone: 701-281-5695
  • Fax:
Mailing address:
  • Phone: 218-686-9810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: