Provider Demographics
NPI:1043608300
Name:WILLISON, CASSANDRA RUTH (CNM)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:RUTH
Last Name:WILLISON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:GREENBANK
Mailing Address - State:WA
Mailing Address - Zip Code:98253-9739
Mailing Address - Country:US
Mailing Address - Phone:360-678-3594
Mailing Address - Fax:360-678-3783
Practice Address - Street 1:3455 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:GREENBANK
Practice Address - State:WA
Practice Address - Zip Code:98253-9739
Practice Address - Country:US
Practice Address - Phone:360-678-3594
Practice Address - Fax:360-678-3783
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60533429367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife