Provider Demographics
NPI:1710219589
Name:WIEBE, CASSANDRA RENEE (LMP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:RENEE
Last Name:WIEBE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4142
Mailing Address - Country:US
Mailing Address - Phone:360-527-1030
Mailing Address - Fax:
Practice Address - Street 1:2228 JAMES ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4142
Practice Address - Country:US
Practice Address - Phone:360-527-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60055619174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist