Healthcare Provider Details

I. General information

NPI: 1831432848
Provider Name (Legal Business Name): CASSANDRA LEE STAPLES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 EDALBERT DR
CINCINNATI OH
45239-7604
US

IV. Provider business mailing address

5400 EDALBERT DR
CINCINNATI OH
45239-7604
US

V. Phone/Fax

Practice location:
  • Phone: 513-741-3100
  • Fax: 513-741-5686
Mailing address:
  • Phone: 513-741-3100
  • Fax: 513-741-5686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN215756
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: