Provider Demographics
NPI:1437696671
Name:WAITE, CASSAUNDRA (RN)
Entity Type:Individual
Prefix:MS
First Name:CASSAUNDRA
Middle Name:
Last Name:WAITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12840 DUSTY WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-5548
Mailing Address - Country:US
Mailing Address - Phone:845-750-7008
Mailing Address - Fax:
Practice Address - Street 1:12840 DUSTY WILLOW RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-5548
Practice Address - Country:US
Practice Address - Phone:845-750-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001264088163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse