Healthcare Provider Details

I. General information

NPI: 1699419465
Provider Name (Legal Business Name): CASSANDRA TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 07/04/2022
Certification Date: 07/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W LEOTA ST
NORTH PLATTE NE
69101-6525
US

IV. Provider business mailing address

7456 S HOMAN PL UNIT 13
SIOUX FALLS SD
57108-8521
US

V. Phone/Fax

Practice location:
  • Phone: 308-568-8000
  • Fax:
Mailing address:
  • Phone: 816-560-6655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR051790
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95221
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101717
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: