Individual provider Active NPI

Cassandra Angela Justice, RN

  • Registered Nurse
  • Palmer, AK
National Provider Identifier
1336465020
Registry record updated Apr 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
RN140163 Issued in GA
Practice address
2500 S Woodworth Loop
Palmer, AK 99645-8984
Phone
(907) 861-6000
NPI assigned
Apr 20, 2010
Last updated
Apr 20, 2010By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 20, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 28575 AK
Registered Nurse 163W00000X RN140163 GA Primary

Addresses

Primary practice location

2500 S Woodworth Loop
Palmer, AK 99645-8984

Mailing address

1150 S Colony Way
Suite # 3 PMB 321
Palmer, AK 99645-6900
Phone (907) 745-0061

Other names 1

  • Miss Cassandra Angela Cannoles Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
28575AKMDRegistered Nurse
RN140163GAMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271721600000",
    "number": "1336465020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 S COLONY WAY",
            "address_2": "SUITE # 3 PMB 321",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996456900",
            "telephone_number": "907-745-0061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 S WOODWORTH LOOP",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996458984",
            "telephone_number": "907-861-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUSTICE",
        "first_name": "CASSANDRA",
        "middle_name": "ANGELA",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-04-20",
        "last_updated": "2010-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AK",
            "license": "28575",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN140163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CASSANDRA",
            "last_name": "CANNOLES",
            "middle_name": "ANGELA",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Palmer, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.