Provider Demographics
NPI:1851709752
Name:CASSAVAW, JOANNE
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:CASSAVAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 COUNTY ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:BRUSHTON
Mailing Address - State:NY
Mailing Address - Zip Code:12916-3916
Mailing Address - Country:US
Mailing Address - Phone:518-529-7324
Mailing Address - Fax:518-529-0190
Practice Address - Street 1:758 COUNTY ROUTE 7
Practice Address - Street 2:
Practice Address - City:BRUSHTON
Practice Address - State:NY
Practice Address - Zip Code:12916-3916
Practice Address - Country:US
Practice Address - Phone:518-529-7324
Practice Address - Fax:518-529-0190
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150972164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse