Provider Demographics
NPI:1902244239
Name:CASSEL, TAMMY SUE (CNA)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:SUE
Last Name:CASSEL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MOSHER AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-1407
Mailing Address - Country:US
Mailing Address - Phone:269-579-0588
Mailing Address - Fax:
Practice Address - Street 1:111 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MI
Practice Address - Zip Code:49037-7417
Practice Address - Country:US
Practice Address - Phone:269-969-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-09
Last Update Date:2013-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI230015692121111376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide