Provider Demographics
NPI:1376067892
Name:ESDOHR, CASSIE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:ANN
Last Name:ESDOHR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:ANN
Other - Last Name:GEHLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-358-9461
Mailing Address - Fax:515-358-9489
Practice Address - Street 1:12493 UNIVERSITY AVE STE 100
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325
Practice Address - Country:US
Practice Address - Phone:515-358-9461
Practice Address - Fax:515-358-9489
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087541363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant