Provider Demographics
NPI:1255744173
Name:DAHLHEIMER-LAWSON, CASSONDRA LANE (PA-C)
Entity type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:LANE
Last Name:DAHLHEIMER-LAWSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 MAIN ST NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1270
Mailing Address - Country:US
Mailing Address - Phone:763-241-0373
Mailing Address - Fax:
Practice Address - Street 1:290 MAIN ST NW
Practice Address - Street 2:SUITE 100
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1270
Practice Address - Country:US
Practice Address - Phone:763-241-0373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2081363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical