MEDICARE: CASSANDRA L WIBLE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209015116	IL
2	363L00000X	Nurse Practitioner	277001899	IL
3	363L00000X	Nurse Practitioner	APN.0998651-NP	CO
4	363L00000X	Nurse Practitioner	202207763NP-PP	OR

General Provider Information

NPI Number	:	1225570286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA L WIBLE FNP

Provider Business Mailing Address
First Line	:	1500 N GRANT ST # 5983
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1859
Country	:	US
Telephone Number	:	618-558-7179
Fax Number	:	949-807-6671

Provider Business Practice Location Address
First Line	:	1500 N GRANT ST # 5983
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1859
Country	:	US
Telephone Number	:	618-558-7179
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2016
Last Update Date	:	02/09/2026

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