Basic Information
| Provider Information | |||||||||
| NPI: | 1265486120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELL | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2061 CHEYENNE CT | ||||||||
| Address2: | |||||||||
| City: | GRAFTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530249368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143262378 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2061 CHEYENNE CT | ||||||||
| Address2: | |||||||||
| City: | GRAFTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530249368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623761934 | ||||||||
| FaxNumber: | 2623752075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 01/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1193-023 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 41965800 | 05 | WI | MEDICAID | 009000261B | 01 | HUMANA | OTHER |