Provider Demographics
NPI:1003241084
Name:WREN, CASSANDRA M (PA)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:M
Last Name:WREN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5679
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405
Mailing Address - Country:US
Mailing Address - Phone:541-485-7546
Mailing Address - Fax:541-345-5254
Practice Address - Street 1:4765 VILLAGE PLAZA LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-485-7546
Practice Address - Fax:541-345-5254
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA164277363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORPA164277OtherOREGON MEDICAL BOARD