Provider Demographics
NPI:1972197325
Name:SANNA, CASSANDRA ELLEN (NP-C)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ELLEN
Last Name:SANNA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:ELLEN
Other - Last Name:HUSK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 14369
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63178-4369
Mailing Address - Country:US
Mailing Address - Phone:314-806-1770
Mailing Address - Fax:
Practice Address - Street 1:12855 N 40 DR STE 125
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8663
Practice Address - Country:US
Practice Address - Phone:314-806-1770
Practice Address - Fax:314-558-9017
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOAG02210135363LA2200X
MO2021012254363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health