Provider Demographics
NPI:1508655093
Name:MILLER, KASANDRA (RN)
Entity type:Individual
Prefix:
First Name:KASANDRA
Middle Name:
Last Name:MILLER
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 1:639 MARQUETTE AVE
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-3102
Mailing Address - Country:US
Mailing Address - Phone:906-440-1165
Mailing Address - Fax:
Practice Address - Street 1:639 MARQUETTE AVE
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-3102
Practice Address - Country:US
Practice Address - Phone:906-440-1165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704310424163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse