Provider Demographics
NPI:1033830526
Name:CARR, CASSANDRA LANE (NMD)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:LANE
Last Name:CARR
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:LANE
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:810 E SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4149
Mailing Address - Country:US
Mailing Address - Phone:208-994-3166
Mailing Address - Fax:
Practice Address - Street 1:810 E SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4149
Practice Address - Country:US
Practice Address - Phone:208-994-3166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath