Healthcare Provider Details

I. General information

NPI: 1952716086
Provider Name (Legal Business Name): CASSANDRA LYNN CASE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 MAIN ST
HURON OH
44839-2542
US

IV. Provider business mailing address

PO BOX 378
SANDUSKY OH
44871-0378
US

V. Phone/Fax

Practice location:
  • Phone: 419-433-6117
  • Fax: 419-433-7226
Mailing address:
  • Phone: 419-609-1112
  • Fax: 419-609-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.15845-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: