Healthcare Provider Details

I. General information

NPI: 1023947603
Provider Name (Legal Business Name): CASSANDRA MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 MAPLE LN
RIVERDALE NE
68870-7149
US

IV. Provider business mailing address

19502 R ST
OMAHA NE
68135-4349
US

V. Phone/Fax

Practice location:
  • Phone: 308-222-0366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number7348538780
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: