Provider Demographics
NPI:1104090034
Name:MANNHARDT, CASSANDRA (ND, RN)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:
Last Name:MANNHARDT
Suffix:
Gender:F
Credentials:ND, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-5719
Mailing Address - Country:US
Mailing Address - Phone:203-576-4126
Mailing Address - Fax:203-576-4106
Practice Address - Street 1:60 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-5719
Practice Address - Country:US
Practice Address - Phone:203-576-4126
Practice Address - Fax:203-576-4106
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT083624163W00000X
CT000386175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No163W00000XNursing Service ProvidersRegistered Nurse