Provider Demographics
NPI:1912728460
Name:CHASE, CASSIDY (RN, PHN)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 FOOTHILL BLVD STE OAKLAND
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2455
Mailing Address - Country:US
Mailing Address - Phone:510-577-1953
Mailing Address - Fax:
Practice Address - Street 1:6955 FOOTHILL BLVD STE OAKLAND
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2455
Practice Address - Country:US
Practice Address - Phone:510-577-1953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95076825163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse