Healthcare Provider Details

I. General information

NPI: 1679563175
Provider Name (Legal Business Name): CASSANDRA ELIZABETH CAMPBELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 N 6TH ST
READING PA
19601-3096
US

IV. Provider business mailing address

145 N 6TH STREET 2ND FL
READING PA
19603-3096
US

V. Phone/Fax

Practice location:
  • Phone: 610-208-4543
  • Fax:
Mailing address:
  • Phone: 610-208-4543
  • Fax: 610-378-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberR55819
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP017265
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: