Provider Demographics
NPI:1063845022
Name:IMPERIAL, KASSANDRA MAE SY (RN)
Entity Type:Individual
Prefix:MS
First Name:KASSANDRA MAE
Middle Name:SY
Last Name:IMPERIAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12240 BROOKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-1992
Mailing Address - Country:US
Mailing Address - Phone:907-887-9074
Mailing Address - Fax:
Practice Address - Street 1:5861 BROOKWOOD CIRCLE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1992
Practice Address - Country:US
Practice Address - Phone:907-887-9074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK35285163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse