Provider Demographics
NPI:1215781802
Name:RATHBURN, CASSANDRA ANN (LVN)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ANN
Last Name:RATHBURN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:ANN
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9765 BILTEER DR
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2662
Mailing Address - Country:US
Mailing Address - Phone:619-552-5016
Mailing Address - Fax:
Practice Address - Street 1:9765 BILTEER DR
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2662
Practice Address - Country:US
Practice Address - Phone:619-552-5016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA185458164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty