Provider Demographics
NPI:1760796551
Name:OUELLETTE, CASSANDRA DESMOND (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:DESMOND
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:R
Other - Last Name:DESMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:1131 WEST ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-6006
Mailing Address - Country:US
Mailing Address - Phone:860-276-6800
Mailing Address - Fax:860-276-6801
Practice Address - Street 1:1131 WEST ST STE 2
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-6006
Practice Address - Country:US
Practice Address - Phone:860-276-6800
Practice Address - Fax:860-276-6801
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2259179363LW0102X, 363L00000X, 363LA2200X
CT12.010920363LA2200X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health