Healthcare Provider Details

I. General information

NPI: 1366919789
Provider Name (Legal Business Name): KASSANDRE MCHALE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HADDON AVE FL 3
CAMDEN NJ
08103-3101
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-988-6260
  • Fax: 856-988-6270
Mailing address:
  • Phone: 856-988-6260
  • Fax: 856-988-6270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ00865700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: