Provider Demographics
NPI:1477833465
Name:BUELL, CASSANDRA CHRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:CHRISTINE
Last Name:BUELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 MOJAVE DR
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-5247
Mailing Address - Country:US
Mailing Address - Phone:503-807-9815
Mailing Address - Fax:
Practice Address - Street 1:2488 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5508
Practice Address - Country:US
Practice Address - Phone:209-948-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 20798363A00000X
CAPA20798363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical