Provider Demographics
NPI:1306954334
Name:LECHEL, KASANDRA ANNE (FNP)
Entity type:Individual
Prefix:
First Name:KASANDRA
Middle Name:ANNE
Last Name:LECHEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3495 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1455
Mailing Address - Country:US
Mailing Address - Phone:810-424-2011
Mailing Address - Fax:
Practice Address - Street 1:1515 W ATHERTON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-5300
Practice Address - Country:US
Practice Address - Phone:810-232-5189
Practice Address - Fax:810-232-4963
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704208256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1306954334Medicaid
MIM23560365Medicare PIN
MI500Z410370OtherBCBSM
MIQ45516Medicare UPIN