Provider Demographics
NPI:1013896760
Name:CASSANDRA L WIBLE FNP-C
Entity type:Organization
Organization Name:CASSANDRA L WIBLE FNP-C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WIBLE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:970-360-5255
Mailing Address - Street 1:1500 N GRANT ST # 5983
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-1859
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 N GRANT ST # 5983
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-1859
Practice Address - Country:US
Practice Address - Phone:618-558-7179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-28
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care