Healthcare Provider Details

I. General information

NPI: 1043608300
Provider Name (Legal Business Name): CASSANDRA RUTH WILLISON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 OLD COUNTY RD
GREENBANK WA
98253-9739
US

IV. Provider business mailing address

3455 OLD COUNTY RD
GREENBANK WA
98253-9739
US

V. Phone/Fax

Practice location:
  • Phone: 360-678-3594
  • Fax: 360-678-3783
Mailing address:
  • Phone: 360-678-3594
  • Fax: 360-678-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP60533429
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: