Provider Demographics
NPI:1780322347
Name:CALLAHAN, CASSANDRA LYNN (RN)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LYNN
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:LYNN
Other - Last Name:CALLAHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:7960 30TH RD
Mailing Address - Street 2:
Mailing Address - City:RAPID RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49878-9347
Mailing Address - Country:US
Mailing Address - Phone:906-241-4576
Mailing Address - Fax:
Practice Address - Street 1:1807 NEUENS RD
Practice Address - Street 2:
Practice Address - City:NIAGARA
Practice Address - State:WI
Practice Address - Zip Code:54151-9165
Practice Address - Country:US
Practice Address - Phone:906-241-4576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26611330163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse