Provider Demographics
NPI:1093113524
Name:CASSISTA, TAMMY MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:MICHELLE
Last Name:CASSISTA
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 1:49 ROCKINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-1861
Mailing Address - Country:US
Mailing Address - Phone:978-401-7776
Mailing Address - Fax:
Practice Address - Street 1:49 ROCKINGHAM AVE
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-1861
Practice Address - Country:US
Practice Address - Phone:978-401-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2270471163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care