Provider Demographics
NPI:1508205188
Name:CASS, NICOLE L (CNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:CASS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 BRADENTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3520
Mailing Address - Country:US
Mailing Address - Phone:614-766-3344
Mailing Address - Fax:614-766-3330
Practice Address - Street 1:5040 BRADENTON AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3520
Practice Address - Country:US
Practice Address - Phone:614-766-3344
Practice Address - Fax:614-766-3330
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14537-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics