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General NPI Number Information
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NPI Number | 1154091973
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Entity Type | Individual
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Provider Name | CASSANDRA JANIE LANDGREN PA
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Gender | Female
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | 2230 WESTMORELAND RD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-4933
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Country | US
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Telephone | 720-261-5177
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Fax |
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Provider Business Mailing Address
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Address Line | 1537 S HIGLEY RD
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City | GILBERT
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State | AZ
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Zip | 85296-4771
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Country | US
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Telephone | 480-257-2700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8814
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License Number State | AZ
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