Provider Demographics
NPI:1184768137
Name:SHOCKLEY, CASSANDARA M (APRN, BC)
Entity type:Individual
Prefix:MRS
First Name:CASSANDARA
Middle Name:M
Last Name:SHOCKLEY
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40580 MOHAWK RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MARCOLA
Mailing Address - State:OR
Mailing Address - Zip Code:97454-9709
Mailing Address - Country:US
Mailing Address - Phone:541-405-3646
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN ROAD EAST
Practice Address - Street 2:MAIL ROUTE MN 008-B213
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343
Practice Address - Country:US
Practice Address - Phone:541-405-3646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR097006513N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily