Provider Demographics
NPI:1033936620
Name:BLACKBURN, CASSANDRA (RN)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20402 N 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3699
Mailing Address - Country:US
Mailing Address - Phone:623-445-5000
Mailing Address - Fax:
Practice Address - Street 1:4035 W ALAMEDA RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-3304
Practice Address - Country:US
Practice Address - Phone:623-445-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ240033163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse