Provider Demographics
NPI:1326210378
Name:GARRETT, CASSANDRA (LPN)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 HAWTHORNE AVE APT 361
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-5158
Mailing Address - Country:US
Mailing Address - Phone:631-882-1769
Mailing Address - Fax:
Practice Address - Street 1:121 HAWTHORNE AVE APT 361
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-5158
Practice Address - Country:US
Practice Address - Phone:631-882-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246835-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse