Provider Demographics
NPI:1477217115
Name:BRANDSTED, CASSANDRA (NP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:BRANDSTED
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CASANDRA
Other - Middle Name:
Other - Last Name:BRANDSTED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1515 KINGS RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-7725
Mailing Address - Country:US
Mailing Address - Phone:605-391-8090
Mailing Address - Fax:
Practice Address - Street 1:353 FAIRMONT BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7375
Practice Address - Country:US
Practice Address - Phone:605-391-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP002188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily