Provider Demographics
NPI:1336228246
Name:KRINGLIE, CASSANDRA L (PA)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:L
Last Name:KRINGLIE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:L
Other - Last Name:BOSTOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2400 32ND AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5800
Mailing Address - Country:US
Mailing Address - Phone:701-234-8820
Mailing Address - Fax:701-234-8918
Practice Address - Street 1:2400 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5800
Practice Address - Country:US
Practice Address - Phone:701-234-8820
Practice Address - Fax:701-234-8918
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10529363AM0700X
NDPAC0357363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND71079Medicaid
ND71079Medicaid