1184161416 NPI number — MRS. CASSANDRA A BROSNAHAN APRN, CNP

Table of content: MRS. CASSANDRA A BROSNAHAN APRN, CNP (NPI 1184161416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184161416 NPI number — MRS. CASSANDRA A BROSNAHAN APRN, CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROSNAHAN
Provider First Name:
CASSANDRA
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHORT
Provider Other First Name:
CASSANDRA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184161416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21209 SHELL STATION ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKFORD
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19945-2457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-381-9329
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2425 N SALISBURY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21801-2138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-210-2543
Provider Business Practice Location Address Fax Number:
443-210-2544
Provider Enumeration Date:
01/25/2017

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:  LG-0001005 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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