Provider Demographics
NPI:1790259430
Name:NEBOSKY-DIAZ, CASSANDRA ANN (PA)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:ANN
Last Name:NEBOSKY-DIAZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:659 DAHARAN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-6538
Mailing Address - Country:US
Mailing Address - Phone:336-210-5920
Mailing Address - Fax:
Practice Address - Street 1:659 DAHARAN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-6538
Practice Address - Country:US
Practice Address - Phone:336-210-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08461363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant