Provider Demographics
NPI:1245657998
Name:CASTLE, CASSANDRA (LPN)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:CASTLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 ROYAL PALM BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3274
Mailing Address - Country:US
Mailing Address - Phone:843-740-1580
Mailing Address - Fax:843-744-3671
Practice Address - Street 1:3963 WHIPPER BARONY LN
Practice Address - Street 2:CHARLESTON COUNTY HEALTH DEPARTMENT/NORTH AREA CLINIC
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7162
Practice Address - Country:US
Practice Address - Phone:843-740-1580
Practice Address - Fax:843-744-3671
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP15095172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker