Provider Demographics
NPI:1497170682
Name:TRAETOW, CASSANDRA RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:RAE
Last Name:TRAETOW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:R
Other - Last Name:SNODDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4343 ALL SEASONS DR STE 140
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1962
Mailing Address - Country:US
Mailing Address - Phone:614-544-1401
Mailing Address - Fax:614-544-1403
Practice Address - Street 1:4343 ALL SEASONS DR STE 140
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1962
Practice Address - Country:US
Practice Address - Phone:614-544-1401
Practice Address - Fax:614-544-1403
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50003999363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000874248OtherANTHEM
OH0099185Medicaid
OH0099185Medicaid