Provider Demographics
NPI:1861249724
Name:YODER, CASSANDRA RENEEE (RN)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:RENEEE
Last Name:YODER
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:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:MAHNOMEN
Mailing Address - State:MN
Mailing Address - Zip Code:56557-0102
Mailing Address - Country:US
Mailing Address - Phone:218-536-1111
Mailing Address - Fax:218-936-6337
Practice Address - Street 1:PO BOX 102
Practice Address - Street 2:
Practice Address - City:MAHNOMEN
Practice Address - State:MN
Practice Address - Zip Code:56557-0102
Practice Address - Country:US
Practice Address - Phone:218-536-1111
Practice Address - Fax:218-936-6337
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2054915163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health