Provider Demographics
NPI:1154091973
Name:LANDGREN, CASSANDRA JANIE (PA)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:JANIE
Last Name:LANDGREN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 S HIGLEY RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4771
Mailing Address - Country:US
Mailing Address - Phone:480-257-2700
Mailing Address - Fax:
Practice Address - Street 1:2230 WESTMORELAND RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4933
Practice Address - Country:US
Practice Address - Phone:720-261-5177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant