Provider Demographics
NPI:1275984254
Name:DEBENHAM, CASSANDRA RENEE (APRN)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:RENEE
Last Name:DEBENHAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7661 S 700 E
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2350
Mailing Address - Country:US
Mailing Address - Phone:801-385-5243
Mailing Address - Fax:
Practice Address - Street 1:7661 S 700 E
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2350
Practice Address - Country:US
Practice Address - Phone:801-385-5243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7574219-4405363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine