Provider Demographics
NPI:1639670128
Name:DENNIS, CASSIE (LVN)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 ARMSTRONG RD
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:TX
Mailing Address - Zip Code:76365-7230
Mailing Address - Country:US
Mailing Address - Phone:940-205-3157
Mailing Address - Fax:
Practice Address - Street 1:194 ARMSTRONG RD
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:TX
Practice Address - Zip Code:76365-7230
Practice Address - Country:US
Practice Address - Phone:940-205-3157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115275164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse