Provider Demographics
NPI:1477842060
Name:SIMONSON, CASANDRA CONNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CASANDRA
Middle Name:CONNIE
Last Name:SIMONSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CASANDRA
Other - Middle Name:CONNIE
Other - Last Name:KRIEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1881 NANI ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1811
Mailing Address - Country:US
Mailing Address - Phone:913-620-1110
Mailing Address - Fax:808-872-4029
Practice Address - Street 1:1881 NANI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1811
Practice Address - Country:US
Practice Address - Phone:913-620-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 17535208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics