Provider Demographics
NPI:1396999702
Name:DEWEESE, CASSONDRA DAWN (BSE)
Entity type:Individual
Prefix:MRS
First Name:CASSONDRA
Middle Name:DAWN
Last Name:DEWEESE
Suffix:
Gender:F
Credentials:BSE
Other - Prefix:MISS
Other - First Name:CASSONDRA
Other - Middle Name:DAWN
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSE
Mailing Address - Street 1:113 MANSON RD APT 101
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-3667
Mailing Address - Country:US
Mailing Address - Phone:501-831-2636
Mailing Address - Fax:
Practice Address - Street 1:4107 RICHARDS RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2653
Practice Address - Country:US
Practice Address - Phone:501-955-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist