Provider Demographics
NPI:1609121128
Name:CULMER, CASSANDRA
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:CULMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205-14 LINDEN BOULEVARD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ST. ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2934
Mailing Address - Country:US
Mailing Address - Phone:718-528-5493
Mailing Address - Fax:718-525-4305
Practice Address - Street 1:20514 LINDEN BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2900
Practice Address - Country:US
Practice Address - Phone:718-528-5493
Practice Address - Fax:718-525-4305
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306170-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse