Healthcare Provider Details

I. General information

NPI: 1164305280
Provider Name (Legal Business Name): CASSANDRA MICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 EMILE ST LEVEL 5
OMAHA NE
68198-0001
US

IV. Provider business mailing address

1126 SANGER ST
OTTAWA IL
61350-1744
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-5031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: