Healthcare Provider Details

I. General information

NPI: 1356737209
Provider Name (Legal Business Name): CASANDRA LYNN ZUMMALLEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASANDRA FRANZ MD

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 10/27/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 2ND ST
NEENAH WI
54956-2883
US

IV. Provider business mailing address

130 2ND ST
NEENAH WI
54956-2883
US

V. Phone/Fax

Practice location:
  • Phone: 920-969-7900
  • Fax: 920-969-7979
Mailing address:
  • Phone: 920-969-7900
  • Fax: 920-969-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number64452-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: