Basic Information
| Provider Information | |||||||||
| NPI: | 1225498744 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | ALLIANCE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 693013826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3087611151 | ||||||||
| FaxNumber: | 3087611139 | ||||||||
| Practice Location | |||||||||
| Address1: | 204 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | ALLIANCE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 693013826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3087611151 | ||||||||
| FaxNumber: | 3087611139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2016 | ||||||||
| LastUpdateDate: | 09/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 111983 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.