Healthcare Provider Details

I. General information

NPI: 1093884561
Provider Name (Legal Business Name): CASSIE L POWERS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COOKS HILL RD
CENTRALIA WA
98531-9073
US

IV. Provider business mailing address

1900 COOKS HILL RD
CENTRALIA WA
98531-9073
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-2889
  • Fax: 360-736-3136
Mailing address:
  • Phone: 360-736-2889
  • Fax: 360-736-3136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN00154640
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: