Provider Demographics
NPI:1457579450
Name:CASSEL, CYNTHIA C (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:C
Last Name:CASSEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:L
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:6300 WEDGEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311
Mailing Address - Country:US
Mailing Address - Phone:763-551-1215
Mailing Address - Fax:
Practice Address - Street 1:6300 WEDGEWOOD WAY
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311
Practice Address - Country:US
Practice Address - Phone:763-551-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1699363A00000X
AZ3601363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant