Healthcare Provider Details

I. General information

NPI: 1285582924
Provider Name (Legal Business Name): CASSANDRA ANN WING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSIE WING

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 W 4TH ST
GRAND ISLAND NE
68803-4119
US

IV. Provider business mailing address

2715 W 4TH ST
GRAND ISLAND NE
68803-4119
US

V. Phone/Fax

Practice location:
  • Phone: 308-258-2415
  • Fax:
Mailing address:
  • Phone: 308-258-2415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: