Provider Demographics
NPI:1023634615
Name:NEWLAND, CASANDRA JANE (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:CASANDRA
Middle Name:JANE
Last Name:NEWLAND
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:CASANDRA
Other - Middle Name:JANE
Other - Last Name:NEWLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:560 W MITCHELL ST
Mailing Address - Street 2:STE 400
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2274
Mailing Address - Country:US
Mailing Address - Phone:231-330-3585
Mailing Address - Fax:
Practice Address - Street 1:560 W MITCHELL ST STE 400
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2274
Practice Address - Country:US
Practice Address - Phone:231-487-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704255241363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704255241OtherSTATE LICENSE