Provider Demographics
NPI:1134881675
Name:MARCELUS, CASSANDRA (RN)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:MARCELUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 BACON ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:IRWINTON
Mailing Address - State:GA
Mailing Address - Zip Code:31042-2561
Mailing Address - Country:US
Mailing Address - Phone:478-946-2273
Mailing Address - Fax:478-946-1000
Practice Address - Street 1:103 BACON ST UNIT C
Practice Address - Street 2:
Practice Address - City:IRWINTON
Practice Address - State:GA
Practice Address - Zip Code:31042-2561
Practice Address - Country:US
Practice Address - Phone:478-946-2273
Practice Address - Fax:478-946-1000
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN102475163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice