Provider Demographics
NPI:1427729979
Name:GUENTHARDT, CASSANDRA A (NP-C)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:A
Last Name:GUENTHARDT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3395 STRONACH RD
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-9489
Mailing Address - Country:US
Mailing Address - Phone:231-510-5554
Mailing Address - Fax:
Practice Address - Street 1:1391 E PARKDALE AVE
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9352
Practice Address - Country:US
Practice Address - Phone:231-398-1878
Practice Address - Fax:231-398-1768
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI470425700207Q00000X
MI4704257000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine