Provider Demographics
NPI:1467021147
Name:OPATZ, CASSONDRA ANN (DNP)
Entity Type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:ANN
Last Name:OPATZ
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WALNUT CIR
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:MN
Mailing Address - Zip Code:56320-1078
Mailing Address - Country:US
Mailing Address - Phone:320-293-5941
Mailing Address - Fax:
Practice Address - Street 1:820 LILAC DR N
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4700
Practice Address - Country:US
Practice Address - Phone:763-205-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily