Provider Demographics
NPI:1588245823
Name:SILLIVENT, CASSANDRA ADELE (LVN)
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:ADELE
Last Name:SILLIVENT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-7560
Mailing Address - Country:US
Mailing Address - Phone:817-243-8013
Mailing Address - Fax:
Practice Address - Street 1:2611 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-7560
Practice Address - Country:US
Practice Address - Phone:817-243-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350540164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse