1124040027 NPI number — LISA CATHERINE KASSE ARNP

Table of content: LISA CATHERINE KASSE ARNP (NPI 1124040027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124040027 NPI number — LISA CATHERINE KASSE ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASSE
Provider First Name:
LISA
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124040027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4215 BURNS RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
PALM BEACH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33410-4625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-694-7776
Provider Business Mailing Address Fax Number:
561-694-3099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4215 BURNS ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PALM BEACH GARDENS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33410-4627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-694-7776
Provider Business Practice Location Address Fax Number:
561-694-3099
Provider Enumeration Date:
07/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP1454462 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)