Provider Demographics
NPI:1780178210
Name:NATION, CASSONDRA MARIE
Entity type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:MARIE
Last Name:NATION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 EAGLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-2008
Mailing Address - Country:US
Mailing Address - Phone:217-280-3726
Mailing Address - Fax:217-670-2582
Practice Address - Street 1:409 EAGLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-2008
Practice Address - Country:US
Practice Address - Phone:217-280-3726
Practice Address - Fax:217-670-2582
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator