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General NPI Number Information
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NPI Number | 1497408314
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Entity Type | Individual
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Provider Name | CASSANDRA MARIE EDLUND AGNP-C, MSN, RN
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Gender | Female
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 5123 JUAN TABO BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-2672
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Country | US
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Telephone | 505-292-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 783 SILVERBERRY CIR SE UNIT B
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City | ALBUQUERQUE
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State | NM
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Zip | 87116-3108
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Country | US
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Telephone | 815-793-7076
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209.024502
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 75418
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License Number State | NM
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