Provider Demographics
NPI:1528249679
Name:CASSIDY, CARLA LORIN (NP)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:LORIN
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:810 VERMONT AVE NW
Mailing Address - Street 2:OFFICE OF QUALITY AND PERFORMANCE 10Q
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20420-0001
Mailing Address - Country:US
Mailing Address - Phone:202-266-4502
Mailing Address - Fax:202-266-4534
Practice Address - Street 1:810 VERMONT AVE NW
Practice Address - Street 2:OFFICE OF QUALITY AND PERFORMANCE 10Q
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20420-0001
Practice Address - Country:US
Practice Address - Phone:202-266-4502
Practice Address - Fax:202-266-4534
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR082400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health