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General NPI Number Information
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NPI Number | 1306762075
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Entity Type | Individual
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Provider Name | CASSANDRA JANE DEWULF FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/26/2026
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Last Update Date | 06/26/2026
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Provider Practice Location Address
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Address Line | 3301 COUNTY ROAD 6 E
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City | ELKHART
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State | IN
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Zip | 46514-7673
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Country | US
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Telephone | 574-264-3561
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Fax |
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Provider Business Mailing Address
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Address Line | 1514 GAULEY RIVER DR
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City | MISHAWAKA
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State | IN
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Zip | 46544-6868
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 28215732A
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License Number State | IN
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