Provider Demographics
NPI:1518385129
Name:VANDERVELDEN, CASSIE L (NP)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:L
Last Name:VANDERVELDEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:551 LINN ST
Mailing Address - Street 2:STE. 150
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1595
Mailing Address - Country:US
Mailing Address - Phone:269-686-5800
Mailing Address - Fax:269-686-5899
Practice Address - Street 1:551 LINN ST
Practice Address - Street 2:STE. 150
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1595
Practice Address - Country:US
Practice Address - Phone:269-686-5800
Practice Address - Fax:269-686-5899
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2016-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704302351363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics