Provider Demographics
NPI:1962110486
Name:MATLAGE, CASSIE MARIE (RN)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:MARIE
Last Name:MATLAGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:MARIE
Other - Last Name:JURGENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3215 CAROLINE DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-1161
Mailing Address - Country:US
Mailing Address - Phone:708-712-8235
Mailing Address - Fax:
Practice Address - Street 1:3215 CAROLINE DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-1161
Practice Address - Country:US
Practice Address - Phone:708-712-8235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.026603363L00000X
IL041407750163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse