Provider Demographics
NPI:1265969612
Name:WILLBOURN, CASSANDRA J (RN)
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:J
Last Name:WILLBOURN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:CASSANDRA
Other - Middle Name:J
Other - Last Name:WILLBOURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CASSANDRA ROBINSON
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:206-764-0502
Mailing Address - Fax:206-764-0516
Practice Address - Street 1:905 24TH WAY SW STE A2
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6033
Practice Address - Country:US
Practice Address - Phone:360-742-5010
Practice Address - Fax:360-742-5015
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60328887163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse