Provider Demographics
NPI:1154682995
Name:WETTER, CASSANDRA M (RD)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:M
Last Name:WETTER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:M
Other - Last Name:HEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1301 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51449-1585
Mailing Address - Country:US
Mailing Address - Phone:712-464-3171
Mailing Address - Fax:712-464-3269
Practice Address - Street 1:1301 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:IA
Practice Address - Zip Code:51449-1585
Practice Address - Country:US
Practice Address - Phone:712-464-3171
Practice Address - Fax:712-464-3269
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01610133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered