Provider Demographics
NPI:1477353803
Name:LEATHERWOOD, CASSANDRA YVETTE (RN)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:YVETTE
Last Name:LEATHERWOOD
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17194 PARKSIDE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2713
Mailing Address - Country:US
Mailing Address - Phone:313-409-4343
Mailing Address - Fax:
Practice Address - Street 1:19011 BIRCHRIDGE ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5807
Practice Address - Country:US
Practice Address - Phone:248-905-3251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704196648163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse