Healthcare Provider Details

I. General information

NPI: 1720919202
Provider Name (Legal Business Name): CASSANDRA NEESE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 STAHL RD
SHEBOYGAN WI
53081-8862
US

IV. Provider business mailing address

3330 STAHL RD
SHEBOYGAN WI
53081-8862
US

V. Phone/Fax

Practice location:
  • Phone: 920-459-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number235724-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: