Provider Demographics
NPI:1508810540
Name:VAJDA, CASSANDRA IRENE (CPNP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:IRENE
Last Name:VAJDA
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:IRENE
Other - Last Name:LUNDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 CENTRA CARE CIR #2300
Mailing Address - Street 2:CENTRACARE CLINIC - WOMEN'S & CHILDRENS
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3610
Mailing Address - Fax:
Practice Address - Street 1:1900 CENTRA CARE CIR #2300
Practice Address - Street 2:CENTRACARE CLINIC - WOMEN'S & CHILDRENS
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR154213363LP0200X
MNR154214-3363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics