Provider Demographics
NPI:1215438189
Name:WIEK, CASANDERA KAY (FNP)
Entity type:Individual
Prefix:
First Name:CASANDERA
Middle Name:KAY
Last Name:WIEK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CASANDERA
Other - Middle Name:KAY
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2025 SLOAN PL STE 35
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2092
Mailing Address - Country:US
Mailing Address - Phone:651-772-1572
Mailing Address - Fax:651-772-1889
Practice Address - Street 1:7180 10TH ST N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-1122
Practice Address - Country:US
Practice Address - Phone:651-242-5890
Practice Address - Fax:651-731-6207
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP5691363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner