Healthcare Provider Details

I. General information

NPI: 1740004340
Provider Name (Legal Business Name): KASANDRA MICHELLE ALLEN CPSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7005 PROSPECT PL NE
ALBUQUERQUE NM
87110-4311
US

IV. Provider business mailing address

7005 PROSPECT PL NE
ALBUQUERQUE NM
87110-4311
US

V. Phone/Fax

Practice location:
  • Phone: 505-390-2080
  • Fax:
Mailing address:
  • Phone: 505-390-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1987
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: