Provider Demographics
NPI:1609238120
Name:CASSENS, ANNE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:CASSENS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16323 STEMMER RIDGE RD NW
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-9477
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16323 STEMMER RIDGE RD NW
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55379-9477
Practice Address - Country:US
Practice Address - Phone:612-750-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1171365163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-20954OtherIBLCE INTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS
MNR1171365OtherBOARD OF NURSING