Healthcare Provider Details

I. General information

NPI: 1750585741
Provider Name (Legal Business Name): NICOLE MARIE CASSLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S UNION AVE STE B3003
TACOMA WA
98405-1803
US

IV. Provider business mailing address

11447 GRIFFIN PL NW
GIG HARBOR WA
98332-9534
US

V. Phone/Fax

Practice location:
  • Phone: 253-572-2842
  • Fax:
Mailing address:
  • Phone: 607-725-3663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101244008
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25916
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21809
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25916
License Number StateNE
# 5
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number60869820
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: