Healthcare Provider Details

I. General information

NPI: 1104100569
Provider Name (Legal Business Name): MICHELLE D'ANNE KASSENS CNM, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NE 87TH AVE
VANCOUVER WA
98664-4896
US

IV. Provider business mailing address

1329 HAM HILL RD
CENTRALIA WA
98531-5231
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-2778
  • Fax: 360-604-1653
Mailing address:
  • Phone: 360-623-0458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP 60237682
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: