Provider Demographics
NPI:1720537483
Name:FURNISS, CASSANDRA (PA-C)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:FURNISS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 STATE ROUTE 28 STE F
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-4940
Mailing Address - Country:US
Mailing Address - Phone:513-981-4050
Mailing Address - Fax:513-322-4859
Practice Address - Street 1:1064 STATE ROUTE 28 STE F
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-4940
Practice Address - Country:US
Practice Address - Phone:513-981-4050
Practice Address - Fax:513-322-4859
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006223363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty