Provider Demographics
NPI:1356737209
Name:ZUMMALLEN, CASANDRA LYNN (MD)
Entity type:Individual
Prefix:
First Name:CASANDRA
Middle Name:LYNN
Last Name:ZUMMALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CASANDRA
Other - Middle Name:
Other - Last Name:FRANZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:130 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2883
Mailing Address - Country:US
Mailing Address - Phone:920-969-7900
Mailing Address - Fax:920-969-7997
Practice Address - Street 1:130 2ND ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2883
Practice Address - Country:US
Practice Address - Phone:920-969-7900
Practice Address - Fax:920-969-7979
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI64452-20208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1356737209Medicaid