Provider Demographics
NPI:1225498744
Name:WOOD, CASSANDRA KAY (NP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:KAY
Last Name:WOOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3826
Mailing Address - Country:US
Mailing Address - Phone:308-761-1151
Mailing Address - Fax:308-761-1139
Practice Address - Street 1:204 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3826
Practice Address - Country:US
Practice Address - Phone:308-761-1151
Practice Address - Fax:308-761-1139
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA103004Medicare PIN