Provider Demographics
NPI:1336465020
Name:JUSTICE, CASSANDRA ANGELA (RN)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:ANGELA
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:CASSANDRA
Other - Middle Name:ANGELA
Other - Last Name:CANNOLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1150 S COLONY WAY
Mailing Address - Street 2:SUITE # 3 PMB 321
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6900
Mailing Address - Country:US
Mailing Address - Phone:907-745-0061
Mailing Address - Fax:
Practice Address - Street 1:2500 S WOODWORTH LOOP
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8984
Practice Address - Country:US
Practice Address - Phone:907-861-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK28575163W00000X
GARN140163163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse