Provider Demographics
NPI:1003345539
Name:WARREN, CASSANDRA (L AC)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 W 77TH ST STE 215
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5158
Mailing Address - Country:US
Mailing Address - Phone:651-395-8385
Mailing Address - Fax:
Practice Address - Street 1:4445 W 77TH ST STE 215
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5158
Practice Address - Country:US
Practice Address - Phone:651-395-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17636171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist