CASSANDRA L ETHERIDGE


Address: 5200 Fairview Blvd, Wyoming, MN 55092-8013
Phone: 6082147055

CASSANDRA L ETHERIDGE (NPI# 1023648235) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1023648235
Entity Type Individual
Full Name CASSANDRA L ETHERIDGE
Credential PA-C
Practice Address 5200 Fairview Blvd
Wyoming
MN 55092-8013
Mailing Address 9036 Lexington Ave N Lowr Unit
Circle Pines
MN 55014-3623
Practice Telephone 6082147055
Mailing Telephone 6082147055
Enumeration Date 2020-01-16
Last Update Date 2020-01-16
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363A00000X Physician Assistant 13229 MN Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 5200 FAIRVIEW BLVD
City WYOMING
State MN
Zip Code 55092-8013

Providers in the same location

NPI Name Taxonomy Address Enumeration
1528061371 Gunnar Jon Erickson Ophthalmology 5200 Fairview Blvd, Wyoming, MN 55092-8013 2005-05-24
1902414378 Fairview Express Care General Practice 5200 Fairview Blvd, Wyoming, MN 55092-8013 2020-07-21
1023652211 Natasha Lackas Speech-Language Pathologist 5200 Fairview Blvd, Wyoming, MN 55092-8013 2019-10-31
1467019414 Terrence Ellis Clinical Exercise Physiologist 5200 Fairview Blvd, Wyoming, MN 55092-8013 2019-05-24
1790341493 Krystal Kraemer Dietitian, Registered 5200 Fairview Blvd, Wyoming, MN 55092-8013 2019-05-17
1225509037 Lauren Downie Dietitian, Registered 5200 Fairview Blvd, Wyoming, MN 55092-8013 2018-12-06
1861977787 Magdalen Rene Gadbois Speech-Language Pathologist 5200 Fairview Blvd, Wyoming, MN 55092-8013 2018-09-26
1285110338 Marie Hudalla Physical Therapist 5200 Fairview Blvd, Wyoming, MN 55092-8013 2018-07-12
1023502697 Molly Levy Nurse Practitioner 5200 Fairview Blvd, Wyoming, MN 55092 2018-06-18
1982118642 Meghan Wellmann Speech-Language Pathologist 5200 Fairview Blvd, Wyoming, MN 55092-8013 2017-11-16
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1821696022 Wyoming Family Dental Dentist 5378 East Viking Blvd., Wyoming, MN 55092 2020-10-12
1851909436 Matthew Rohlf Dentist 5378 E Viking Blvd, Wyoming, MN 55092 2020-07-20
1669013280 Christina Marie Orde Technician 4855 261st Street, Wyoming, MN 55092 2019-10-04
1609425966 Faith Bouttell Technician 25423 Heims Lake Circle, Wyoming, MN 55092 2019-09-10
1275875031 Fairview Express Care Clinic/Center 5130 Fairview Blvd, Suite 101, Wyoming, MN 55092 2013-03-20
1023385242 St. Croix Orthopaedics, P.a. Durable Medical Equipment & Medical Supplies 5200 Fairview Blvd., Wyoming, MN 55092 2011-11-17
1902851876 Tamara Piroska Petrac-halatsis Obstetrics & Gynecology 5200 Fairview Boulevard, Ob/gyn Department, Wyoming, MN 55092 2006-05-22
1376922070 Carli Lynn Ceder Physical Therapist 5130 Fairview Blvd, Wyoming, MN 55092 2015-05-27
1396087433 Fairview Health Services Durable Medical Equipment & Medical Supplies 5130 Fairview Blvd, Suite 104, Wyoming, MN 55092 2013-03-26
1598007726 Fairview Health Services Prosthetic/Orthotic Supplier 5130 Fairview Blvd, Suite 103, Wyoming, MN 55092 2013-03-26
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Taxonomy Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1427686534 Mason L Hutchens Physician Assistant 4246 Stonebridge Dr Sw Apt 8, Wyoming, MI 49519-5225 2020-04-01
1285841841 Rebecca Anne Hull Physician Assistant 2215 44th St Sw, Wyoming, MI 49509-4950 2007-05-16
1609930262 Jennifer Lynne Swinburne Physician Assistant 2221 Health Drive Sw, Suite 2100, Wyoming, MI 49519-9606 2006-12-20
1548377708 Laura Kooy Physician Assistant 585 36th St Sw, Wyoming, MI 49509-4002 2006-08-24
1750498721 Larry Arnold Brewer Physician Assistant 2929 Burlingame S.w., Wyoming, MI 49519 2006-08-24
1922025725 Elizabeth A Sayers Physician Assistant 2122 Health Dr Sw Ste 133, Wyoming, MI 49519-9698 2006-07-16
1720046626 Sherrill D Busboom Physician Assistant 2093 Health Dr Sw Ste 100, Wyoming, MI 49519 2006-05-02
1013524404 Payton Marsh Physician Assistant 2060 Health Dr Sw, Wyoming, MI 49519-9687 2020-09-29
1881223642 Allison Donth Physician Assistant 5838 Metro Way Sw, Wyoming, MI 49519-9619 2020-04-03
1235790353 Amanda Wolterink Physician Assistant 5838 Metro Way Sw, Wyoming, MI 49519-9619 2019-06-28
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Competitor

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City WYOMING
Zip Code 55092

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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