Provider Demographics
NPI:1689958092
Name:SUNDBERG, CASSIE MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:MARIE
Last Name:SUNDBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CASSIE
Other - Middle Name:MARIE
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1414 W FAIR AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-5406
Mailing Address - Country:US
Mailing Address - Phone:906-225-4500
Mailing Address - Fax:906-225-3919
Practice Address - Street 1:901 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-1367
Practice Address - Country:US
Practice Address - Phone:906-486-4431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006216363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant