Provider Demographics
NPI:1285230383
Name:KRILL, CASSANDRA LOUISE
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LOUISE
Last Name:KRILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4426 OSAGE AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3981
Mailing Address - Country:US
Mailing Address - Phone:224-388-8121
Mailing Address - Fax:
Practice Address - Street 1:450 S EASTON RD
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-3215
Practice Address - Country:US
Practice Address - Phone:215-572-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant