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NPI Code Detail

MEDICARE: CASSANDRA JANE DEWULF FNP-C

MEDICARE: CASSANDRA JANE DEWULF FNP-C
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
1207R00000XInternal Medicine Physician28215732AIN

General Provider Information

NPI Number : 1306762075
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSANDRA JANE DEWULF FNP-C
Provider Business Mailing Address
First Line : 1514 GAULEY RIVER DR
Second Line :
City : MISHAWAKA
State : IN
Zip : 46544-6868
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3301 COUNTY ROAD 6 E
Second Line :
City : ELKHART
State : IN
Zip : 46514-7673
Country : US
Telephone Number : 574-264-3561
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2026
Last Update Date : 06/26/2026

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