Provider Demographics
NPI:1609990415
Name:VANCE, CASSANDRA (MSN, WHNP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:VANCE
Suffix:
Gender:F
Credentials:MSN, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4648
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37864-4648
Mailing Address - Country:US
Mailing Address - Phone:865-453-1032
Mailing Address - Fax:865-429-2689
Practice Address - Street 1:227 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3838
Practice Address - Country:US
Practice Address - Phone:865-453-1032
Practice Address - Fax:865-429-2689
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012564363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health