Healthcare Provider Details

I. General information

NPI: 1952540346
Provider Name (Legal Business Name): CASSANDRA LEE COYLE ANP, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSANDRA LEE BERNARD NP, CDE

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 07/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 TROY RD RENNSELAER COUNTY PLAZA
RENSSELAER NY
12144-9518
US

IV. Provider business mailing address

279 TROY RD RENNSELAER COUNTY PLAZA
RENSSELAER NY
12144-9518
US

V. Phone/Fax

Practice location:
  • Phone: 518-286-1922
  • Fax: 518-283-3225
Mailing address:
  • Phone: 518-286-1922
  • Fax: 518-283-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number470004
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF306771
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: